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CASES

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.
Girl’s papular rash will not respond to treatmentThe mother of a healthy 5-year-old girl brings her to the office for evaluation of 2 itchy plaques on her right ankle that have worsened over the last 10 days despite treatment for possible tinea corporis with topical clotrimazole 1% ointment and hydrocortisone 2.5% ointment. A fungal culture is pending.
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.
Girl’s blistering rash spreads to eyes and faceA healthy 9-year-old female presents with a 1-day history of fever, progressive rash, conjunctivitis, and superficial oral ulcers.
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.
Father, son share similar blue bumpsA father brings his 8-year-old son to the office for evaluation of new, asymptomatic blue bumps that have appeared on the boy’s chest over the last several months (Figure). The dad notes that he has had similar lesions as well.
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.
Acute pruritic eruption on a child’s face and handsYou are asked to evaluate a healthy 9-year-old girl with an itchy rash on her face, neck, and hands for a week. She had a similar eruption 1 month ago that resolved over several days. Although she has a history of poison ivy, her parents knew of no exposure. There was no history of new topical skin products. However, she had begun to eat more seasonal fruits recently, including strawberries, grapes, and mangos.
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.
Newborn‘s rash is more than skin deepA healthy newborn girl returns for a follow-up visit at age 7 days, and she is exhibiting multiple disseminated red macules and papules of varying sizes. While in the nursery, several red blanching macules had been noted on her trunk at age 2 days.

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