Case Presentation of a Nine-Year-Old Female With Chronic Recurrent Multifocal Osteomyelitis.

Multifocal bone pain in a pediatric patient prompts a broad differential diagnosis, which should include chronic recurrent multifocal osteomyelitis (CRMO), particularly when the patient has a personal or family history of autoimmune diseases or chronic inflammatory disorders. CRMO is a difficult diagnosis, as several similar disorders must be ruled out first, and it requires extensive verification based on clinical, radiological, and pathological criteria. It often mimics other medical diagnoses, including Langerhans cell histiocytosis and infectious osteomyelitis. Maintaining a high index of suspicion for CRMO is important to minimize unnecessary medical testing, optimize pain control, and preserve physical function. We present the case of a nine-year-old female who presented with multifocal bone pain and was diagnosed with CRMO.

Posterior reversible encephalopathy syndrome associated with Henoch Schonlein Purpura in a pediatric patient.

Henoch Schonlein Purpura is a rare hypersensitivity vasculitis that is commonly associated with pediatric patients. It typically presents with purpuric rash to the lower extremities, abdominal pain and microscopic hematuria; however, it may also be associated with intussusception, glomerulonephritis and hypertension. Posterior Reversible Encephalopathy Syndrome is a poorly understood, rare condition associated with cerebral edema and segmental vasoconstriction. Typically characterized by headaches, seizures, and visual changes, which is presumed to be associated with rapid increases in blood pressure. We present the case of a 6-year-old female who developed Posterior Reversible Encephalopathy Syndrome as a complication from Henoch Schonlein Purpura.

A teenager with fever, chest pain, and respiratory distress during the coronavirus disease 2019 pandemic: a lesson on anchoring bias.

Symptoms of coronavirus disease 2019 overlap with other important illnesses affecting young adults. We report a case of a 17-year old male presenting to the emergency department in the midst of a pandemic with symptoms of coronavirus disease 2019. He had fever, dyspnea, chest pain, and myalgias, with bilateral infiltrates on chest radiograph, and developed septic shock secondary to infectious thromboembolic events. However, his blood cultures grew group G streptococcus secondary to his oropharyngeal infection, and he experienced an infectious thrombus in the internal jugular vein, consistent with the rare but well-described Lemierre's syndrome. This case report calls attention to the importance of maintaining differential diagnoses and thereby minimizing the biases and assumptions that come with clinical care during a pandemic.

Neuroblastoma presenting as hip pain and skull prominence in a child.

Neuroblastoma is a common cancer in children especially those under 5-years old, however they can have varied presentations that may make diagnosis difficult. Neuroblastoma is not usually high on a clinician's differential for a child's gait dysfunction. We describe a case of a 6-year-old female who presented to the Emergency Department for new onset right hip pain. She had associated gait disturbance and pain with ambulation as well as a new lump on her right parietal skull. An MRI of the brain, lumbar spine, and pelvis revealed the diagnosis of a left adrenal neuroblastoma that had metastasized to the femur, the lumbar spine, and the skull. This case shows the importance of early suspicion of malignancy in a patient with seemingly disparate symptoms to ensure early intervention.

The Effect of Telemedicine on Resource Utilization and Hospital Disposition in Critically Ill Pediatric Transport Patients.

PURPOSE: Pediatric transport teams rely on communication to report patient data to medical command officers, who create care plans and determine disposition. Common destinations are the emergency department (ED), pediatric intensive care unit (PICU), or regular inpatient care area (RIPCA). Telephone report does not result in complete understanding of the patient's condition. Further workup in the ED is often required. Telemedicine allows the patient to be directly seen; parents to be interviewed; and laboratory studies, radiographs, and vital signs to be reviewed. We hypothesized that telemedicine would improve understanding of the patient and result in more accurate disposition. DESIGN: Patients within our hospital from 2012 to 2013 were compared with patients transported using our telemedicine program from April 2014 to April 2015. RESULTS: From 2012 to 2013, a total of 4,662 transports were performed. Of these, 4,067 were inbound transports, 2,302 of these patients were sent to ED (56.6%), 1,062 were sent to RIPCA (26%), and 431 were sent to PICU (10.6%). Over a year-long period of telemedicine implementation, 212 patients used telemedicine and were analyzed. ED utilization decreased to 27% (p < 0.0001), PICU increased to 34.4% (p < 0.0001), and RIPCA rates remained the same at 28% (p = 0.203). Of ED dispositions, 58.6% were admitted to RIPCA for further care, 13.7% to PICU for escalation of care, and 24.1% were discharged. Of RIPCA dispositions, 10% had rapid responses; 0 had code blues. Of PICU dispositions, 90.4% had care escalation; 9.6% were observed in the PICU without escalation. CONCLUSION: Telemedicine use in transported pediatric patients can positively alter disposition patterns.