Contemporary Pediatrics Cases

Boy’s progressing rash could delay surgeryA preoperative evaluation is requested for a 15-year-old boy who is a renal transplant patient maintained on oral mycophenolate mofetil and tacrolimus. His parents are worried that an itchy rash on his hands and feet, which has been progressing over the last 4 months, will result in postponement of his surgery.
Right question resolves teen’s pain dilemmaA 16-year-old girl presents to an emergency department (ED) accompanied by her boyfriend to report a 24-hour history of right lower quadrant pain. The pain is associated with midline lower back pain and light vaginal bleeding (1 to 2 tampons per day). She has experienced some nausea but no vomiting.
Pruritic vesicles erupt on a boy’s legsA healthy 12-year-old boy with eczema shows up at the office with an incredibly itchy rash on his legs that has exploded over the last 48 hours. He has a history of dry skin to which his mother regularly applies various moisturizers, including calendula oil.
Infant with failure to thrive and hypotoniaA 4-month-old girl arrives at the clinic for a well-child visit. Her mother voices concerns about the infant’s poor weight gain, slow feeding habits, and physical delays such as head lag, poor grasp reflex, and rolling over.
Itchy blisters bother a 12-year-old girlThe mother of a 12-year-old girl brings her daughter to the office for evaluation of recurrent, itchy red bumps and blisters on her legs. The mother gets the same rash recurrently as well.
Tight, shiny membrane encases newborn’s skinAfter a cesarean delivery at 30 weeks, a 1430-gram premature female neonate was noted to have generalized thick, dark brown scale forming a tight membrane over her entire skin surface. Her mother was a healthy 19-year-old gravida 1 with normal prenatal screening ultrasound and laboratory studies. Family history did not reveal any congenital malformations or genetic disorders.
Recurrent brown spots in an infant girlA mother brings her healthy 6-month-old girl to the outpatient clinic with disseminated, asymptomatic, golden-brown bumps that occasionally become red and swollen.
Small-for-age toddler is unable to walkA 22-month-old African American boy born at 38 weeks by normal vaginal delivery presents to a local hospital from a private pediatric office for failure to thrive. He was seen by his pediatrician until aged 1 month but was lost to follow-up. His delay in walking prompted his mother to reestablish care at age 22 months.
Infant’s disseminated rash is twice misdiagnosedA frustrated mother carries her 2-month-old son into the office for evaluation of a diffuse bright red rash with dramatic hypopigmentation. Scalp, neck, axillary, and diaper areas are involved.
Newborn with persistent hypoglycemiaA full-term male infant was born to a 33-year-old gravida 3, para 3 mother. The prenatal course was uncomplicated, without gestational diabetes; the mother received prenatal care at an out-of-state institution. At the delivery, however, the baby was notably macrosomic, with shoulder dystocia and perinatal distress requiring positive pressure ventilation.