A Case Report on Subcutaneous Emphysema and Pneumomediastinum Following a Routine Dental Procedure.

Subcutaneous emphysema (SE) and pneumomediastinum are rare complications of air beneath the skin layers and in the mediastinal space, respectively, following routine dental procedures. A few cases exist in the literature. A 53-year-old female presented to the emergency department shortly after a cavity filling, with marked swelling of her right orbit, face, and neck. Physical examination and computed tomography (CT) revealed subcutaneous emphysema and pneumomediastinum. The patient was treated with prophylactic antibiotics for one week and Peridex rinse twice daily. Subcutaneous emphysema and pneumomediastinum cases have been associated with potentially life-threatening sequelae and infections. Although these conditions are almost exclusively benign and self-limiting, physicians should consider the associated fatal complications and manage accordingly. Dental providers should be able to recognize this complication and provide patients with appropriate guidance.

Facial Nerve Palsy in a Five-Month-Old Infant.

Facial nerve palsy is a common neurological disorder, and the etiology is categorized as either congenital or acquired. Even after extensive workup, a vast majority of cases are deemed idiopathic. Treatment of acquired facial nerve palsy in pediatrics is essential to prevent long-term aesthetic and functional complications. The prognosis is favorable in pediatric patients and those treated with corticosteroids.

Inability to Ambulate in a Pediatric Patient Secondary to an Aneurysmal Bone Cyst With Associated Pathological Fracture.

Bone pain in pediatric patients is exceedingly common, with etiologies ranging from benign lesions such as fibrous dysplasia and enchondromas to potentially devastating, life-threatening malignancies such as Ewing's sarcoma or osteosarcoma. Given the low yield of physical examination and routine laboratory workup, pediatric patients with bone pain or an inability to ambulate warrant further workup. The initial workup should consist of imaging with radiography. A large majority of patients will have a resolution of symptoms without intervention and will have normal imaging. When radiographic imaging has suspicious findings, expert consultation is warranted because differentiating between benign and malignant processes on imaging can be challenging. Here we present a case of a six-year-old male with progressive worsening leg pain who was found to have a rare aneurysmal bone cyst with an associated pathologic fracture requiring open reduction and internal fixation.

Appendicitis in a Six-Month-Old Child With Coincidental Pneumonia.

Appendicitis is an exceedingly uncommon diagnosis in infancy and, thus, is typically not considered a differential diagnosis for this population. Its atypical presentation, with a wide range of clinical manifestations, creates a diagnostic challenge for physicians. Along with this, a patient's inability to articulate their pain adds another layer of diagnostic challenge. Here, we present the case of a six-month-old infant with a complicated hospital course of pneumonia and subsequent ileus, who was later found to have appendicitis with a surrounding abscess.

Infant With Recurrent Vomiting and Poor Weight Gain Secondary to an Aberrant Subclavian Artery.

Failure to thrive (FTT) is a term commonly used to characterize slower-than-expected weight gain. While inadequate caloric intake is the predominant cause, failure to thrive is a manifestation of undernutrition often resulting from the interplay of multiple etiologies. This case highlights the diagnosis and management of an infant who presented with recurrent large-volume emesis and poor weight gain secondary to esophageal compression from an aberrant right subclavian artery (ARSA).

A Five-Month-Old Boy With Hypotonia, Electrolyte Derangements, and Failure to Thrive.

Failure to thrive in the setting of profound hypotonia and multiple electrolyte derangements is a challenging constellation of findings that offers a broad differential diagnosis for providers to consider. Initial management should focus on the stabilization of the patient and correction of potential life-threatening electrolyte derangements. Once completed, the diagnosis should be sought, and in this case, many were considered and ultimately ruled out with thorough history and physical examination. Laboratory abnormalities revealed the final diagnosis of pseudohypoaldosteronism and connected the case. With proper treatment, our patient had a resolution of laboratory anomalies along with improved growth and tone.

Diffuse alveolar hemorrhage in a pediatric patient with systemic lupus erythematosus.

A 15-year-old female patient was initially transferred due to symptomatic anemia following months of menorrhagia, fatigue, dyspnea, and weight loss. Early during her hospital course, pulmonary complications occurred with the development of respiratory failure secondary to bilateral pleural effusions. She was managed with bi-level pressure support ventilation alternating with a high-flow nasal cannula. An extensive workup resulted in a diagnosis of systemic lupus erythematosus: C3 level was 9 mg/dl (81-157 mg/dl) and her C4 level was 2 mg/dl (12-39 mg/dl); ANA titer was 1:5120 in a homogenous pattern. Scl-70 was qualitatively positive, quantitative anti-dsDNA level was 1044 IU/ml (<150 IU/ml), hemoglobin at presentation was 6.3 g/dl (11.8-15.7 g/dl), and her albumin level was 2.8 g/dl (3.5-5.0 g/dl). The patient was started on prednisone 60 mg daily and then transitioned to cyclophosphamide. Her symptoms improved initially; however, several days into admission she developed acute respiratory decompensation with blood-tinged sputum. Her hemoglobin levels, which had stabilized, began decreasing from 9.5 to 7.4 g/dl. Chest radiography showed new bilateral hazy infiltrates, and computerized tomography of the chest showed bilateral pleural effusions and parenchymal disease. A bronchoscopy confirmed a diagnosis of diffuse alveolar hemorrhage. The patient was treated with plasma exchange therapy and her corticosteroids were restarted. She completed a course of steroids and at initial pulmonology follow-up and showed stable pulmonary status with an improvement of her symptoms.

Clitoromegaly Secondary to Exogenous Androgen Exposure From Paternal Skin to Skin Transfer.

Clitoromegaly is the abnormal enlargement of the clitoris. Its etiology is often divided into congenital and acquired causes, leading to a differential diagnosis that is quite broad. Workup often includes serum hormone testing, imaging studies, and sometimes an investigation into genetic and nonhormonal causes, which can be obtained from a detailed patient history. Exposure to exogenous or endogenous androgens can directly stimulate and enlarge the clitoris, resulting in early virilization. Transdermal testosterone gel can be transferred from the skin of an adult to the skin of a child. Topical testosterone gel is an approved therapy for the treatment of hypoandrogenism in males. While it offers a convenient means of treatment, there is a concern about unintentional exposure to females and children from skin contact with the application site. Here, we report a case of an infant who presented to a pediatric endocrinology clinic for clitoromegaly that was possibly due to exogenous exposure to testosterone.

A 14-Year-Old Female With Several-Week History of Rash, Worsening Diffuse Arthralgias, and Fevers.

Macrophage activation syndrome (MAS) as the initial presentation of systemic juvenile idiopathic arthritis (sJIA) is an uncommon and difficult diagnosis to ascertain. However, it remains critical to establish the diagnosis since MAS is a potentially life-threatening systemic inflammatory condition. Prompt recognition can lead to early initiation of treatment with corticosteroids and overall improved outcomes. Here, we present a case of a 14-year-old female with MAS as the initial manifestation of sJIA.

Recurrent spontaneous pneumothorax in a 15-year-old female associated with electronic cigarettes.

Pneumothorax as a sequela of vaping is a relatively recent complication being described in the literature. Smoking has classically been associated with an increased risk of pneumothorax, and emerging evidence is showing that electronic cigarettes (e-cigarettes) likely carry some of the same risks. Since e-cigarettes increased in popularity, especially among the adolescent population, there has been a reported increased incidence of lung injury, including pneumothorax. We present a case of a 15-year-old female with a history of e-cigarette use admitted for recurrent pneumothorax with failure to re-expand requiring surgical intervention.

Acute Ischemic Stroke in an Eight-Year-Old Male With Elevated Factor VIII Activity and SARS-CoV-2 Antibodies.

Acute ischemic stroke (AIS) is a significant source of morbidity and mortality and is one of the top causes of death in the United States. Of these patients, most are elderly individuals, compared to a limited proportion of cases seen in pediatrics. AIS is classically associated with age-dependent atherosclerotic disease processes secondary to comorbidities such as diabetes and hypertension. When considering the pediatric population, stroke is far less common and often requires workup of other underlying etiologies that create a hypercoagulable state. Here we present a case of an eight-year-old male with a left middle cerebral artery (MCA) ischemic stroke in the setting of increased factor VIII activity and SARS-CoV-2 antibodies.

A Case of Acalvaria in a Full Term, Live Born Male Infant.

Acalvaria is a rare cranial vault defect characterized by the presence of the cerebellum and cerebral cortex with the absence of the calvarium above the orbits, intact facial structures, and the presence of dura mater. Unfortunately, this diagnosis comes with a dim prognosis that is not compatible with life long-term. First-trimester diagnosis with ultrasonography can establish the diagnosis. If imaging is equivocal, advanced imaging with fetal MRI has a role to aid in distinguishing between similar cranial vault defects that fall on the spectrum including anencephaly, exencephaly, and acrania. We present the case of a term male infant with known acalvaria diagnosed incidentally on prenatal ultrasound that was delivered by cesarean section to a G3P3 mother at the time of delivery with two prior uncomplicated pregnancies. Maternal history was rather insignificant except for gestational diabetes and gestational hypertension well-controlled without medication. After initiation of comfort measures only, the infant expired on day of life two.