Case Studies

A healthy 10-year-old male presents for evaluation with a 3-year history of an asymptomatic and progressive, mildly pruritic rash over his head and trunk. The first lesion appeared on his back 3 years ago, and numerous other lesions developed insidiously afterward. The patient’s father states that the lesions fade during the winter and become more prominent during the summer. Failed treatment included hydrocortisone. What's the diagnosis?

A mildly overweight 8-year-old Hispanic female in rural Colorado is brought to her primary care provider’s office with right neck pain and right-sided neck swelling of a day’s duration. The patient’s mother also stated that her daughter had a maximum temperature (T-max) of 102°F that started that morning. The patient denied any sore throat, rash, headache, rhinorrhea, cough, nasal congestion, abdominal pain, vomiting, or diarrhea. What's the diagnosis?

A healthy, afebrile, 12-month-old girl presents for evaluation with an asymptomatic nodule on her left cheek that has been present for 3 weeks. She was initially seen by her pediatrician, diagnosed with cellulitis, and prescribed an oral antibiotic, which was not administered by her parents.

A healthy 5-week-old girl presents for evaluation of rapidly growing, flat-topped red papules on the left side of her face.

A 24-year-old G2P1001 African American female at 38.2 weeks of gestation was induced for labor for a fetus with prenatally diagnosed intrauterine growth restriction (IUGR). She subsequently delivered via normal spontaneous delivery. The infant initially latched well at the breast, was normoglycemic and normothermic, but shortly after birth had had a significant episode of blood-tinged emesis (not deemed to be swallowed maternal blood) and was transferred to the transitional nursery for further evaluation.

A healthy 5-year-old boy with a 6-month history of asymptomatic 2-mm to 3-mm papules on his legs presents for evaluation of a red, slightly itchy rash that just developed on the back of his right knee. What's the diagnosis?

A 6-year-old female with history of previously resolved iron-deficiency anemia presents to the emergency department (ED) for numerous episodes of nonbloody, nonbilious vomiting and diffuse abdominal pain that began on the day of presentation. She had initially presented to her pediatrician who felt a large left-upper-quadrant abdominal mass and referred her to the ED for further evaluation. She has no associated diarrhea or urinary symptoms. What's the diagnosis?

An otherwise healthy 5-month-old girl presents with an asymptomatic, rapidly growing, firm, smooth nodule on the side of her left fifth finger since she was 2 months of age.

A healthy 3-year-old girl presents for evaluation of light brown spots on her trunk and extremities that have appeared over the last 2 years. The spots are not symptomatic but the girl’s parents are worried that she could have neurofibromatosis.

A previously healthy 15-year-old female presents to the emergency department (ED) with complaints of right-sided neck swelling, pain, decreased range of motion, and fever for 3 days. She also reports a sore throat and mouth pain with decreased oral intake. She denies any rhinorrhea, shortness of breath, difficulty swallowing, vomiting, or dental pain. What's the diagnosis?

A 3-year old male presents with 3 days of fever (maximal temperature, 105°F), diffuse abdominal pain, and several episodes of nonbilious, nonbloody emesis and loose nonbilious, nonmucousy stools. On day 3 of illness, he was seen at an urgent care clinic where he was diagnosed with acute otitis media and prescribed amoxicillin and ondansetron. He could not tolerate any oral intake and developed red eyes, abdominal pain, and redness of his hands and feet. Later that same night, he presented to the pediatric emergency department and was admitted to the pediatric ward for management of his fever, abdominal pain, and dehydration.

A 3-month-old boy presents for evaluation of a diffuse asymptomatic rash that began on his scalp and skin creases 6 weeks ago and has spread over his trunk and extremities. This week he has begun to scratch at his neck and abdomen.

An 11-year-old male presents to the emergency department (ED) with complaint of 2 days of focal, crampy, periumbilical abdominal pain associated with anorexia, fever, and 1 episode of emesis. What's the diagnosis? 

A healthy 14-year-old girl with a progressive asymptomatic rash on her arms, legs, trunk, and face presents for evaluation. She was treated for eczema with minimal improvement.

A healthy 12-year-old girl presents to the clinic with 2 days of low-grade fever and enlarging, painful, tense bullae on both hands. She had recently been diagnosed with streptococcal pharyngitis and was being treated with oral cefixime.

A 15-year-old adolescent Caucasian male with no significant past medical history presented to the clinic with gradually worsening left ankle pain over the past 2 weeks, ever since he started his football practice. He complained of dull aching pain at the lower end of his left leg for the past 4 months, which was slightly relieved by over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). He twisted his left ankle and noticed further worsening pain, which prompted this doctor visit.

A healthy 11-year-old boy is brought to the office for evaluation of asymptomatic reticulated rash that started on his ankles 3 weeks ago and since has spread to his shins and the tops of both feet. He is on no medications and has had no history of trauma or recent illness. What's the diagnosis?

The patient, an 8-year-old male who recently immigrated to the United States from El Salvador, initially presented to the emergency department (ED) for a cough. The next day, he went to the general pediatrics clinic for follow-up and was noted to have a significant history of recurrent fractures.

A 4-year-old girl presents to the emergency department (ED) with a 12-hour history of progressively worsening episodic left lower quadrant (LLQ) abdominal pain and nonbilious emesis. There was no history of fever, diarrhea, hematochezia, constipation, or dysuria. The child was previously healthy, did not take any medications, and had no history of prior surgery.

The parents of a 2-month-old boy return to the office for a well-child visit. The infant has a history of hypotonia and poor head control but is growing normally. His parents noted streaky patterns of hypopigmentation over his trunk and extremities shortly after birth and felt they were likely just “birthmarks.”

An 11-day-old, full-term male presents to the emergency department (ED) with a 2-day history of decreased range of motion of his right upper extremity.

A 16-year-old girl presents to the clinic for acne follow-up and mentions that her palms wrinkle significantly after only a few minutes of immersion in water. She is otherwise well and has no significant past medical history.

A previously healthy 4-year-old male, born late preterm by urgent cesarean delivery with an uncomplicated postnatal course, presents to the outpatient clinic for a chief complaint of worsening cough over the past 5 months. He denies current fever, rhinorrhea, shortness of breath, diarrhea, or vomiting. His cough has been worsening in severity and frequency, and mostly occurs during the daytime.

An 8-year-old boy is brought to the office for evaluation of a persistent itchy rash on his extremities, trunk, and face. Although the rash has been present for longer than 3 months, individual skin lesions change from hour to hour and occasionally the rash clears completely only to recur several hours later. He is otherwise healthy with no known allergies, changes in diet, medication use, or recent illness.

A previously healthy 8-year-old boy presents to the dermatology clinic with a progressively worsening elbow rash over the course of the last week. The rash does not itch. He spent the previous weekend sailing on the Chesapeake Bay. His pediatrician prescribed a course of cephalexin as well as a trial of topical antiviral ointment, neither of which improved the rash. The patient denies any other new exposures. 

A 16-year-old male with a history of nephrotic syndrome and gastritis presents to the emergency department (ED) with worsening emesis, diarrhea, and abdominal pain of 3-weeks’ duration.

A 6-day-old, late-preterm male neonate presents to his pediatrician’s office with bilious emesis and is admitted for further evaluation. He was born at 36 weeks and 6 days via spontaneous vaginal delivery to a 23-year-old G4P4 mother with negative serologies, negative antenatal Group B Streptococcus testing, and no significant prenatal events. His stay in the newborn nursery was unremarkable. The neonate is exclusively breastfed, has no history of rectal bleeding, and passed meconium within the first 24 hours.

A 33-year-old female, G3P1011, was transferred from an outside facility at 33 weeks and 6 days gestation for anticipated preterm delivery secondary to preeclampsia. On prenatal ultrasound, her fetus was diagnosed with an omphalocele and delivery was preferred at an institution with a neonatal intensive care unit to manage the infant.

A 7-month-old girl presents to her pediatrician’s office with a 1-week history of fevers and upper respiratory symptoms. What's the diagnosis?

A 5-month-old previously healthy, full-term female presented to a pediatric emergency department with 2 weeks of left leg swelling. Her parents denied any history of trauma, pain, fevers, weight loss, and easy bruising or bleeding, and family history was negative for cancer. The patient had been feeding and eliminating well.