Pediatrics Case Studies

Case Studies in Pediatrics

• Case 1: A 14-year-old boy presents with a mildly itchy rash spreading across his chest and back, following cleavage lines. The most likely diagnosis is Pityriasis rosea.

• Case 1 Discussion: Pityriasis rosea typically affects children and young adults, beginning with a single herald patch followed by a diffuse papulosquamous rash. The rash often follows Langer's lines. Many other conditions can mimic pityriasis rosea, but secondary syphilis is a concern.

• Case 2: A 5-year-old boy presents with scrotal pain and swelling of the left testicle. Appropriate management includes ultrasound evaluation with Doppler color flow.

• Case 2 Discussion: Testicular torsion should be suspected in patients with acute scrotal pain and swelling. Prompt diagnosis is critical to preserve testicular viability.

• Case 3: An 8-year-old with abdominal pain has intussusception. The most likely cause is a colon polyp.

• Case 3 Discussion: Intussusception is the most frequent cause of intestinal obstruction in infants, often resulting from common causes for intussusception such as polyps, Meckel's diverticulum, and viral enteritis, but can also be caused by various other factors.

• Case 4: A 12-year-old obese boy presents with nocturnal bilateral leg pain, without limping. The most likely diagnosis is "growing pains".

• Case 4 Discussion: Growing pains are a self-limiting, benign condition characterized by bilateral leg pain, occurring only at night, without limping.

• Case 5: A 12-year-old boy has joint swelling, fevers, and a rash. Laboratory results show anemia, leukocytosis, and thrombocytosis. Juvenile rheumatoid arthritis (JRA) is suspected. First-line treatment is Ibuprofen.

• Case 5 Discussion: JRA is a diverse group of diseases; it is different from adult rheumatoid arthritis and requires distinguishing among subtypes (pauciarticular, polyarticular, and systemic). The first line treatments are typically NSAIDs like ibuprofen.

• Case 6: An 8-year-old asthmatic with wheezing is given albuterol. Peak expiratory flow rate (PEFR) is 75%. The next appropriate step is to add an oral steroid.

• Case 6 Discussion: Early treatment of asthma exacerbations is crucial for preventing progression. Short-acting beta2-agonists are first-line treatment, but additional measures such as oral corticosteroids may be needed for severe cases or persistent symptoms.

• Case 7: An 18-month-old girl has a urinary tract infection (UTI). Appropriate treatment includes renal ultrasound and voiding cystourethrography (VCUG).

• Case 7 Discussion: Practice guidelines typically recommend renal ultrasound to screen for anatomical abnormalities in children 2 to 2 years of age presenting with first UTI. VCUG is performed in cases of complex UTIs to confirm or eliminate the potential of anatomical problems or other conditions such as reflux, scarring, or obstruction.

• Case 8: A 13-year-old girl has a sore throat, fevers, and bilateral knee pain. An elevated sedimentation rate is observed. The most likely diagnosis is acute rheumatic fever.

• Case 8 Discussion: Acute rheumatic fever is a complication of group A streptococcal pharyngitis. It is characterized by arthritis, carditis, erythema marginatum, subcutaneous nodules and/or Sydenham's chorea.

• Case 8 (additional): A child presents to the emergency room with abdominal pain. An abdominal series shows a "bird's beak" sign. The most likely diagnosis is intussusception.

• Case 9: The condition of sigmoid volvulus is rare in children/adolescents, often diagnosed through barium enema. Usually presents with abdominal pain/distress, and often resolving spontaneously. It can become life threatening if not addressed promptly.

• Case 10: A newborn presents with jaundice (bilirubin level of 18 mg/dL). Appropriate treatment is to begin phototherapy.

• Case 10 Discussion: Hyperbilirubinemia is common in newborns but high levels warrant interventions; phototherapy is a standard treatment for jaundice in infants.

• Case 11: A 12-year-old boy has progressive hip pain radiating to the thigh and knee. Pain is elicited with abduction and adduction, and radiographs show acetabular dysplasia. The most likely diagnosis is slipped capital femoral epiphysis.

• Case 11 Discussion: Slipped capital femoral epiphysis (SCFE) is a condition where the ball portion of the femur (head) slides out of place from its socket, concerning commonly in adolescents especially those with obesity.

• Case 12: A 4-year-old boy presents with patchy hair loss, scalp inflammation and scrapings showing hyphae. Treatment of choice is topical antifungals.

• Case 12 Discussion: Tinea capitis, a fungal scalp infection, commonly presents with hair loss, inflammation and often indicated through microscopic examination of scrapings obtained from the affected area showing hyphae.

• Case 13: Presenting with a slapped-cheek appearance, a low-grade fever and malaise is characteristic of erythema infectiosum (fifth disease).

• Case 13 Discussion: Erythema infectiosum is a viral infection characterized by a distinct facial rash that resembles being slapped.

• Case 14: A 3-year-old boy has recurrent ear infections. The appropriate management is to implement single dose prophylactic antibiotics nightly.

• Case 14 Discussion: Recurrent otitis media may be treated effectively through a proactive approach, using prophylactic antibiotics to prevent further infections.

• Case 15: With symptoms such as fever, runny nose, cough, and wheezing, a 4-month-old child is likely infected with RSV (Respiratory Syncytial Virus).

• Case 15 Discussion: RSV is a common respiratory virus, especially in young children, that typically causes symptoms similar to the common cold but potentially worsening to pneumonia in severe cases.