Contemporary Pediatrics Cases

Girl with rash and muscle weaknessThe mother of a healthy 10-year-old girl brings her child to the office for evaluation of new onset “eczema.” The rash is asymptomatic and began on the patient's upper eyelids, later spreading to her chest and extremities over several weeks. The child complains of difficulty riding her bicycle.
Treat plays trick on a 3-year-old boyA 3-year-old boy presents to the emergency department (ED) with a 1-day history of irritability and listlessness. According to his parents, he was well until the night before when he began to behave abnormally, becoming excessively tired approximately 2 hours after eating dinner. During the night, the boy slept poorly, sporadically awakening with crying followed by brief periods of calmness. The morning of presentation, he was difficult to arouse with intermittent fussiness and reluctance to ambulate.
Linear papular eruption grows on boy’s neckA father brings his 12-year-old son to the clinic for evaluation of a skin eruption that has been on the back of the boy’s neck for a year, but which just began to extend behind his ear. The rash is asymptomatic, and the otherwise healthy patient is annoyed that he has to spend a beautiful morning in a physician’s office.
Peeling rash in a 4-year-old boyThe mother of a 4-year-old boy, whose family recently emigrated from Haiti, brings him to the pediatric mobile clinic for evaluation of a rash that had begun 11 days earlier as an eruption of vesicular, pruritic papules on the bilateral lower extremities and had spread to the buttocks and medial thighs with sparing of the face. The skin eruption was followed by desquamation of the skin on his palms and soles.
Boy’s fever and rash after insect biteThe parents of a 4-year-old boy who lives in eastern Maryland near the Pennsylvania line are worried about an expanding rash on his back, which started as a small red bump a week ago following a summer picnic. The boy has had a low-grade fever and has not been acting like himself for a few days.
Pearl-like mass on a girl’s tympanic membraneDuring a routine office visit for mild acute nasal congestion and possible diminished hearing, an isolated, small, pearl-like mass was noted just posterior to the umbo of the left tympanic membrane of a 5-year-old girl.
Hyperpigmentation around a teen’s eyeAn adolescent girl is referred by her pediatrician to dermatology for evaluation of a birthmark on her face.
Boy with fever, cough, and oral lesionsA previously healthy, 16-year-old Hispanic boy initially presents to the clinic with a 5-day history of tactile fevers, achy malaise, congestion, and a dry cough. He was afebrile with negative rapid strep and monospot tests, but was prescribed fluticasone, benzonatate, and ibuprofen for a presumed upper respiratory infection. He was encouraged to return if symptoms did not improve.
Hypothermia and emesis in a newbornThe patient, a 7-day-old, small-for-gestational-age female (birth weight, 2.21 kg), born by vaginal delivery at 37 weeks to a G1P0 mother, presented to the pediatric emergency department for hypothermia and emesis at the recommendation of her pediatrician.
Vesicular rash in an infant with eczemaThe parents of a healthy 6-month-old boy with eczema bring him to the office for evaluation of a rapidly progressive rash on his arms, legs, face, and back. He had a low-grade fever and loose stools for 2 days last week.