Fussiness and New-Onset Diarrhea for 2 Weeks in a 9-week-old Girl
| Autor: | Rachel A. Long, Andrew K. Boulos |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Diarrhea
medicine.medical_specialty Supine position medicine.diagnostic_test Respiratory rate business.industry Physical examination Feeding Behavior Gastroenterology Irritable Mood Blood pressure medicine.anatomical_structure Abdominal ultrasonography White blood cell Erythrocyte sedimentation rate Internal medicine Pediatrics Perinatology and Child Health medicine Humans Female Leukocytosis medicine.symptom business |
| Zdroj: | Pediatrics In Review. 42:562-565 |
| ISSN: | 1526-3347 0191-9601 |
| DOI: | 10.1542/pir.2020-002691 |
| Popis: | 1. Andrew K. Boulos, MD* 2. Rachel A. Long, DO* 1. *University of Texas Southwestern Medical Center and Children’s Medical Center, Dallas, TX A 9-week-old girl with a normal perinatal course, who has been otherwise well, presents to the pediatric emergency department (ED) with a 2-week history of fussiness when lying supine. She has 3 days of decreased oral intake and loss of her social smile. She is brought to her pediatrician for inconsolability and new-onset diarrhea. A complete blood cell (CBC) count was performed revealing leukocytosis (white blood cell count, 40,000/uL (40 × 109/L), prompting referral to the ED. In the ED she develops a fever (102°F [38.9°C]). The remainder of her vital signs are as follows: heart rate, 170 beats/min; respiratory rate, 38 breaths/min; blood pressure, 98/62 mm Hg; and oxygen saturation 98% on room air. Her skin is warm and flushed, and she is crying inconsolably, with irritability consistently worsened by abdominal palpation, but no fullness or masses are appreciated. The perianal examination reveals slow leakage of thin, pink-tinged fluid from the anus without perianal fissures. The physical examination findings are otherwise normal. The CBC count is significant for a hemoglobin level of 8.5 g/dL (85 g/L) and a white blood cell count of 27,300/uL (27.3 × 109/L), with 53.4% neutrophils and 30.8% lymphocytes. Her C-reactive protein level and erythrocyte sedimentation rate are 16.6 mg/dL (166 mg/L) and 78 mm/hr, respectively. Fecal occult blood is positive. Initial laboratory evaluation includes a complete metabolic panel; lactate dehydrogenase; uric acid; urinalysis; nasopharyngeal multiplex polymerase chain reaction for respiratory viral pathogens; and cerebrospinal fluid cell count, glucose, protein, and smear, which are normal. A left lateral decubitus abdominal radiograph shows mild right colonic distention with a nonspecific air-fluid level (Fig 1). Abdominal ultrasonography reveals a hypoechoic mass arising in the presacral space (Fig 2). Pelvic magnetic resonance imaging (MRI) with intravenous gadolinium infusion reveals a multilobulated mass with central … |
| Databáze: | OpenAIRE |
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