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Infant With Persistent Fever and FussinessA 4-week-old boy with tactile fever for the past 24 hours and fussiness of 2 weeks' duration is referred to the emergency department (ED).
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Cystic Hygroma in a 1-Year-Old GirlThe parents of this 1-year-old girl brought her for evaluation of a neck mass of sudden onset (A). They had first noticed the mass on the morning of presentation. The child had cold symptoms and had been snoring, but she had no history of fever, shortness of breath, wheezing, or stridor. Her activity level and appetite had not changed.
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Photoclinic: Foreign-Body IngestionA 12-year-old otherwise healthy boy was referred to a sports medicine clinic for back pain of 7 months' duration. The pain, which originated to the right of his thoracic spine, was associated with shooting hockey pucks. Results of his physical examination were normal.
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Drug Eruptions: The Benign-and the Life-Threatening“Drug rash” is a common pediatric complaint in both inpatient and outpatient settings. This term, however, denotes a clinical category and is not a precise diagnosis. Proper identification and classification of drug eruptions in children are important for determining the possibility of-and preventing progression to-internal involvement. Accurate identification is also important so that patients and their parents can be counseled to avoid future problematic drug exposures.
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The Uncontrollable Child: Family and Educational InterventionsIt is estimated that about 20% of children and adolescents meet criteria for a mental health disorder, and a high percentage of these youths are impaired by disruptive behavior problems.
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A Wormian Bone in a NeonateWormian bones (anterior fontanellar bones) are extra islands of bone within the calvarial sutures of the skull.
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Acute UrticariaCircumscribed erythematous lesions developed on the back and abdomen of this 19-month-old boy. The rash was mildly pruritic. The parents gave the child 1 dose of diphenhydramine, and the rash resolved after an hour. About 12 hours later, new lesions developed on the face, neck, and upper back. The child was given the same treatment and the symptoms resolved. The following morning, widespread lesions were noted on the child's face, neck, trunk, and extremities.
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Case in Point: Bladder KnotsThe patient was a 6-year-old boy who had Menkes syndrome and bladder diverticula. He was receiving care at home with sterile intermittent catheterization.
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Podcast: How Safe is Vaccination? Answers For Worried ParentsHere, in the second in a series of podcasts, Dr Ellen Clayton reviews findings of a landmark Institute of Medicine study on vaccine safety and offers information about specific vaccines that may be very useful to you when you answer questions from worried parents.
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Boy With Thick Plaques on His Palms and SolesAt his first well-child visit after a family move, an 8-year-old boy was noted to have bilateral erythematous plaques on the surfaces of his hands and feet. Mother reported that the condition had been present since he was 2 or 3 months old. Patient’s father and other male relatives on the paternal side (uncles, grandfather, great-grandfather) were similarly affected. No other associated symptoms, such as hyperhidrosis, reported. The child did not have a history of eczema, asthma, or food allergies; however, he did have a history of allergic rhinitis and occasional pruritus.
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A Wormian Bone in a NeonateWormian bones (anterior fontanellar bones) are extra islands of bone within the calvarial sutures of the skull.
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Photoclinic: Cutaneous Calcinosis in a Child With Tertiary HyperparathyroidismPhotoclinic: Cutaneous Calcinosis in a Child With Tertiary Hyperparathyroidism
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Genetic Disorders: 4-Day-Old Boy With Multiple AbnormalitiesA 4-day-old boy was transferred to our institution for evaluation of multiple anomalies. He was born to a gravida 2 para 1 mother at 38 weeks of gestation. He weighed 3288 g at birth. Antenatal ultrasonograms at 5, 6, and 7 months had revealed short bones in the legs. The mother was subsequently lost to follow-up--until now.
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Photoclinic: Adverse Reaction to MMR ImmunizationThis 12-month-old girl presented with a diffuse rash that was first noticed by the child's day-care provider a day earlier. A fever (temperature of 39.4°C [103°F]) subsequently developed.
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Pityriasis Lichenoides Et Varioliformis Acuta in a 7-Year-Old BoyA 7-year-old boy was brought for evaluation of a nonpruritic, nonpainful, evolving polymorphic rash that began on the torso and spread to the extremities, face, palms, and soles over a 2-week period. He had been otherwise healthy and had no history of constitutional symptoms.
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A Brain Tumor Presenting as Chronic Intermittent StridorA 2-year-old previously healthy girl was brought to her pediatrician with the chief complaint of persistent noisy breathing. Two months earlier, the child had an upper respiratory tract infection (URI) with rhinorrhea, cough, noisy breathing, and wheezing. All symptoms had resolved except the abnormal breathing. Physical examination findings were unremarkable. A lateral neck x-ray film demonstrated subglottic narrowing, thought to be consistent with croup. Laryngoscopic examination by an otolaryngologist did not reveal any pathology.
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Dyskeratosis Congenita: An Inherited Bone Marrow Failure SyndromeAbnormal pigmentation, nail dystrophy, and leukoplakia may signal dyskeratosis congenita.
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Case in Point: Insights on a "Global" IssueAs an avid reader of Consultant for Pediatricians, I would like to comment on a recently published case involving an 8-year-old boy with an erythematous left eyelid ("Photo Quiz," January 2005, page 24).
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Radiology Quiz1. A 4-year-old girl was brought to the emergency department by her parents on a Sunday afternoon. Because of a clinical history of right upper quadrant pain and trace hematuria, abdominal radiographs were obtained. What do they show?
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Complications of ChickenpoxAfter several days of suffering fever, headache, and malaise, a 17-year-old boy noticed a rash developing over much of his body. He sought medical attention and was admitted to the hospital.
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Molluscum Contagiosum on the Face of a 4-Year-Old BoyDespite curettage several months earlier, the facial rash on this 4-year-old boy had spread across both cheeks and was now mildly pruritic.
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Cerebral Palsy: A Multisystem ReviewABSTRACT: Most cases of cerebral palsy (CP) are the result of congenital, genetic, inflammatory, anoxic, traumatic, toxic, and metabolic disorders. A minority of cases result from asphyxia at birth. Nearly three-quarters of children with CP aged 7 years had a normal neurological evaluation at birth. Abnormal motor development usually provides the first diagnostic clue. Neuroimaging is recommended if the cause of CP has not been established with perinatal imaging. MRI is preferred to CT. Management of the multisystemic manifestations begins with a comprehensive medical evaluation by a multidisciplinary team that includes family members. Therapy is aimed at maximizing the patient's level of function. Key areas include ambulation, cognitive skills, activities of daily living, hygiene, and rehabilitation into society.
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Omental Cyst Presenting as Acute AbdomenA 2-year-old girl was transferred to the pediatric ICU from a nearby community hospital because of nonremitting, generalized abdominal pain associated with fever and vomiting. Her symptoms had begun 3 days earlier and had progressively worsened despite treatment with antibiotics, pain medication, and fluids.
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Asthma Therapy Complicated by Peters Plus SyndromeThe authors describe the case of a 2-year-old girl with severe persistent asthma whose disease management was complicated by this rare clinical diagnosis.
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Case in Point: Lead Poisoning in a Young BoyA 2-year-old African American boy was brought for evaluation of symptoms of an upper respiratory tract infection and intermittent abdominal pain.
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Infant With PurpuraA 9-week-old Caucasian infant is brought to the primary care physician for evaluation of purpura and petechiae. His parents noted the bruising the previous night, which grew progressively worse throughout the next day. The lesions seemed to appear "out of the blue" without apparent cause, including trauma.
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Newborn With Wrinkled Abdomen and Other AnomaliesPrune belly syndrome is a rare condition, classically referred to as a triad of abdominal wall musculature deficiency, bilateral cryptorchidism, and other urological abnormalities, although the clinical presentation can vary. A case history here.
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Photo Essay: Hyperpigmented MaculesThis 13-year-old boy has a Becker nevus--also called Becker melanosis, because the lesions do not contain nevus cells. This common lesion is characterized by the abrupt onset of hyperpigmentation that gradually expands; it appears at or before adolescence.
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Hypopigmented Patches in Infant With a History of SeizuresFour-month-old Hispanic boy brought for evaluation because of hypopigmented patches on his skin and a history of seizures. Infant was the product of an uncomplicated pregnancy; born at 40 weeks' gestation to a 16-year-old gravida 1, para 1 mother who received appropriate prenatal care. At birth, he had multiple hypopigmented patches on his face, torso, and extremities. At age 2 months, he was hospitalized for new-onset seizures.
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Photoclinic: MRSA Skin Abscess and OsteomyelitisThis lesion on the chest of a 6-week-old infant had developed over 2 days (A). It began as a small mass just below the right nipple. Initially, there was no tenderness or erythema; within 2 days, the lesion had begun to drain green-yellow and then white purulent exudate.
