Robert Giusti, MD

A 16-year-old Asian American girl presented for evaluation of a cyst on the anterior neck that had become enlarged and inflamed over the past 9 months. She also had a productive cough for 1 month. There was no history of night sweats, weight loss, or fever.

A 12-year-old boy from Pakistan presented with weakness, night sweats, anorexia, and chronic cough of 2 months' duration. He had undergone spinal surgery about 5 months before immigrating to the United States when acute paralysis, kyphosis, and a prominent midline hump (gibbus deformity) developed in his thoracic spine. The child appeared pale and weak but in no acute respiratory distress. His weight was 20.5 kg (45 lb). He had difficulty in walking without assistance. Muscle wasting was noted in the arms and legs, and he had a healing lesion on the left elbow that drained pus. Other physical examination findings were unremarkable except for a fever (temperature of 37.2°C [99°F]) and the gibbus deformity.