A 5-year-old boy with a history of allergies and asthma presents with fever (temperature of 40°C [104°F]), headache, cough, vomiting, and diffuse pain in and around the chest area on the right side. The patient has never traveled and has no sick contacts. A chest radiograph is obtained (A). Laboratory studies reveal a total serum white blood cell count of 25,300/μL, with atypical lymphocytes. A CT scan of the chest is also obtained (B).
What empiric treatment is most reasonable? ❍ Cyclophosphamide, doxorubicin, and vincristine ❍ Trimethoprim/sulfamethoxazole ❍ Ceftriaxone and azithromycin ❍ Isoniazid, rifampicin, ethambutol, pyrazinamide
A 7-year-old girl had growth of pubic hair for the past 6 months. The hair was initially limited to the labia majora and then extended gradually into the pubic area. She grew 8 cm (3.1 in) in the past year. Her health history was unremarkable; she was not taking any medications.
One of the more common conditions pediatricians diagnose is deformity of the skull. The term "plagiocephaly," from the Greek words plagio (oblique, slanted, or twisted) and kephale (head), simply describes an asymmetrical cranium. Although no human head is truly symmetrical, even small skull deformities in infants may cause concern among parents and physicians.
This 16-year-old boy had slowly progressive hypopigmented lesions on the lower extremities for the past 4 years. He also had atopic dermatitis, asthma, and allergic rhinitis. His 38-year-old mother had Hashimoto thyroiditis. None of his immediate family members had a similar skin disorder.
Like many physicians, I find it difficult to care for a patient with a terminal disease—a discomfort heightened when the patient is an ebullient, beautiful child. I first saw Colby at age 9 months, when she was referred to me for genetic consultation. She had chronic pulmonary disease and growth delay, which her pediatrician and subspecialists suspected were indicators of genetic disease.
A 26-month-old girl presented to the general nephrology clinic for evaluation of chronic renal insufficiency. During the examination, the physician noted green discoloration of the teeth (Figure).
This benign but impressive neonatal eruption progresses through several stages, beginning with pustules that quickly rupture and leave flat macules with collarettes of scale, as shown here. The pustules may rupture in utero, and the neonate may present at birth with the macules, as was the case in this baby boy.
This 16-year-old boy with nailpatella syndrome (NPS) presented for routine follow-up. As an infant, he had surgical correction for clubfeet. His medical care team consisted of an orthopedic surgeon who prescribed supportive orthotics for his knees and elbows; an endocrinologist who prescribed growth hormone therapy for failure to gain weight and height; and a nephrologist who evaluated him regularly for proteinuria and hypertension.
A 9-month-old boy has had a pruritic facial rash (A and B) that has resisted topical therapy. A topical antifungal, topical antibiotics, and 1% hydrocortisone cream have all failed to clear the eruption. Another 9-month-old boy has had a similar rash (C), with no response to topical therapy. Both infants have the same condition and a family history of atopy. What is this condition—and can you identify the cause?
A 7-year-old girl had growth of pubic hair for the past 6 months. The hair was initially limited to the labia majora and then extended gradually into the pubic area. She grew 8 cm (3.1 in) in the past year. Her health history was unremarkable; she was not taking any medications.
One of the more common conditions pediatricians diagnose is deformity of the skull. The term "plagiocephaly," from the Greek words plagio (oblique, slanted, or twisted) and kephale (head), simply describes an asymmetrical cranium. Although no human head is truly symmetrical, even small skull deformities in infants may cause concern among parents and physicians.
This 16-year-old boy had slowly progressive hypopigmented lesions on the lower extremities for the past 4 years. He also had atopic dermatitis, asthma, and allergic rhinitis. His 38-year-old mother had Hashimoto thyroiditis. None of his immediate family members had a similar skin disorder.
A 26-month-old girl presented to the general nephrology clinic for evaluation of chronic renal insufficiency. During the examination, the physician noted green discoloration of the teeth (Figure).
This benign but impressive neonatal eruption progresses through several stages, beginning with pustules that quickly rupture and leave flat macules with collarettes of scale, as shown here. The pustules may rupture in utero, and the neonate may present at birth with the macules, as was the case in this baby boy.
A 9-month-old boy has had a pruritic facial rash (A and B) that has resisted topical therapy. A topical antifungal, topical antibiotics, and 1% hydrocortisone cream have all failed to clear the eruption. Another 9-month-old boy has had a similar rash (C), with no response to topical therapy. Both infants have the same condition and a family history of atopy.
