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Baby boy bleeds into neck hemangiomaA 4-month-old boy presents with sudden onset of a massive hematoma on the right side of his neck and bruising on his legs. At age 2 weeks, he was noted to have developed 4 superficial infantile hemangiomas on his scalp and mid-back, as well as a 1-cm subcutaneous mass on the right side of his neck. All the lesions continued to grow, and he was started on oral propranolol at age 3 months. Although the superficial red plaques on his scalp and back stopped growing, the lesion on his neck continued to grow slowly.
Neonate with bilateral breast enlargementA 10-day-old female infant presented to the clinic for a weight check. She was feeding well, but her mother was concerned about her newly swollen breasts.
New violaceous nodules in a neonateFollowing an uncomplicated pregnancy, labor, and delivery, a healthy 13-day-old girl presents for evaluation with a 2-day history of firm, violaceous nodules on her mid-upper back and right arm just above the axilla.
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.
Protuberant blister over newborn’s lumbar spineA healthy full-term newborn presented with a prominent sacral dimple within an oval patch. Ultrasound showed no evidence of spinal anomalies, and the child was discharged home. Three days later, the patch became elevated, red, and moist appearing, and she was brought to the emergency department (ED) for further evaluation of the “growing blister.”
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?
Rapidly growing nodule on infant’s posterior thighThe parents of a healthy 5-month-old boy bring him to the office for evaluation of an enlarging yellowish nodule on the back of his right thigh. It started as a pink macule several months ago and became yellow and lumpy over the last month. The infant was born at term and has grown and developed normally. His parents deny any trauma, but report occasional bleeding from the surface of the nodule. They deny any new medications or outdoor exposures. There is no history of new topical skin products.
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.