Contemporary Pediatrics Puzzler

Child with abnormal eye lesionsA 12-year-old girl is referred to the office after a routine dilated eye exam shows unusual retinal lesions. The child has been having headaches for the past 2 years that are described as mostly in the vertex with no other associated vomiting symptoms. Headaches are intermittent and usually relieved with ibuprofen.
Suspicious fever of unknown originA 5-month-old Hispanic boy, previously healthy, presents to the emergency department (ED) for 5 days of fever, 3 days of diarrhea and rash, and 2 days of vomiting. He had been diagnosed with acute otitis media by his primary care physician 3 days prior to his presentation and started on amoxicillin. The parents brought their son to the ED because of his persistent fever up to 104°F and decreased oral intake. He has no recent travel and no known sick contacts. His immunizations are up to date and he has never been hospitalized. He was born in the United States, full term with an uncomplicated birth history.
Can you solve these 6 puzzling cases?We know you love a diagnostic challenge. Can you crack these 6 puzzling cases?
Child’s ear pain progresses to leg pain, arm pain, and feverAn 8-year-old girl is admitted to the hospital with complaints of right ear pain, right leg pain, left arm pain, and fever after a week of worsening symptoms.
Infant girl develops bulging sacral massA 3-week-old female presented to the emergency department with a 3-day history of a progressively enlarging, erythematous, seemingly painful lump on her back.
Infant’s seizures and skull fracture could point to child abuseA 5-month-old Hispanic male presented to the emergency department (ED) at a children’s hospital in the Northeast United States directly from his daycare after caretakers witnessed 2 shaking, seizure-like episodes. The episodes lasted 1 to 2 minutes in the setting of a fever as palpated by the parents.
Pallor and swelling in an athlete’s upper armA 15-year-old female presents to the emergency department of a community hospital with acute onset of duskiness in her left arm.
Nervous teenager’s hands turn blueThe father of a healthy 15-year-old girl brings her to the emergency department (ED) for evaluation of blue hands.
Delayed menarche with normal pubertal growthA 14-year-old female presents for a wellness visit. On history, she is noted to not have started her menstrual cycle but on physical exam has significant breast and pubic hair development since the age of 10 years.
Boy with ear pain and facial weaknessA 13-year-old boy with poorly controlled type 1 diabetes (T1D) presents to the emergency department (ED) for evaluation of left ear pain and left facial weakness.