Eczema<p><img src="/sites/default/files/transfer/1012cfpDCeczemaThumb_thumb.jpg" alt="Subacute eczema" style="margin: 5px; float: left;" height="68" width="90">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.<br>What is this condition—and can you identify the cause?</p>
Nail-Patella Syndrome<p><img src="/sites/default/files/transfer/hands.png" width="177" height="122" style="display: block; float: left; margin-left: 8px; margin-right: 8px; border: 1px solid black;"><span style="font-size: x-small;">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.</span></p>
Transient Neonatal Pustular Melanosis<p><img src="/sites/default/files/transfer/baby_rash.png" width="150" height="120" style="display: block; float: left; margin-left: 8px; margin-right: 8px; border: black 1px solid;">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.</p>
Hyperbilirubinemia<p><img src="/sites/default/files/transfer/Hyperbilirubinemia_teaser_pic.jpg" style="float: left; margin-left: 8px; margin-right: 8px; border: 1px solid black;" height="173" width="150">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 (<strong>Figure</strong>).</p>
Chronic Pulmonary Disease and Growth Delay<P><SPAN class=article-text><SPAN><IMG style="BORDER-BOTTOM: black 1px solid; BORDER-LEFT: black 1px solid; DISPLAY: block; FLOAT: left; MARGIN-LEFT: 8px; BORDER-TOP: black 1px solid; MARGIN-RIGHT: 8px; BORDER-RIGHT: black 1px solid" src="/sites/default/files/transfer/colby.png" width=150 height=182></SPAN></SPAN>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.</P>
Positional Plagiocephaly<P><STRONG><IMG style="BORDER-BOTTOM: black 1px solid; BORDER-LEFT: black 1px solid; DISPLAY: block; FLOAT: left; MARGIN-LEFT: 8px; BORDER-TOP: black 1px solid; MARGIN-RIGHT: 8px; BORDER-RIGHT: black 1px solid" src="/sites/default/files/transfer/baby_head_3.png" width=200 height=129></STRONG><SPAN style="FONT-SIZE: x-small; FONT-WEIGHT: bold"></SPAN>One of the more common conditions pediatricians diagnose is deformity of the skull. The term "plagiocephaly," from the Greek words <EM>plagio</EM> (oblique, slanted, or twisted) and <EM>kephale</EM> (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.</P>
Genital LesionsA case of premature adrenarche, and a case of isolated scrotal hair of infancy.
Self-Test Your Diagnostic Acumen<p><strong><img src="/sites/default/files/transfer/Ceftriaxone_and_azithromycin_teaser_pic.jpg" style="float: left; margin-left: 8px; margin-right: 8px;" height="279" width="200"></strong><span style="font-size: x-small;">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 (<strong>A</strong>). 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 (<strong>B</strong>).<br></span></p><p><span style="font-size: x-small;"><strong>What empiric treatment is most reasonable?</strong></span><br><span style="font-size: x-small;">❍ Cyclophosphamide, doxorubicin, and vincristine</span><br><span style="font-size: x-small;">❍ Trimethoprim/sulfamethoxazole</span><br><span style="font-size: x-small;">❍ Ceftriaxone and azithromycin</span><br><span style="font-size: x-small;">❍ Isoniazid, rifampicin, ethambutol, pyrazinamide</span></p>