No abstract
TREATMENT AND OUTCOME: -Testosterone 200mg IM injection -Two weeks later, patient noted scrotal pain and was found to have testicular cyst on ultrasound. He noted less fatigue and more energy within one week of treatment.-Vitamin D 50,000 IU qwk x 8 wk -Patient noted improvement during treatment with return to baseline after cessation. He was then continued on Vitamin D3, 2000 IU, twice daily for maintenance. (No relationships reported)HISTORY: JN was a 20 mo male whose right leg became entangled in the crib rails. Limp ensued, followed by 1 week history of refusal to bear weight on R leg. He had a 1 month history of subjective daily fevers. He was recently diagnosed with a pre-eruption cyst, in light of gum discoloration.MEDICAL HISTORY: 36 weeks GA, eczema, feeding problems, multiple food allergies, iron deficiency anemia, pica, FTT, humerus fracture. Diet-rice cereal, rice, ground beef, beans. Dev-appropriate. Imm UTD.PHYSICAL EXAMINATION: Vitals: Temp 36.7 C, Wt 9.08 kg(<5%), Ht 76 cm (<5%), Head circ 49 cm (75%), BP 106/60 Playful and interactive. Irritable during R leg exam. No edema, ecchymosis, erythema or increased warmth. Neurovascularly intact. Actively moving lower extremities. Tenderness to palpitation-R tibia. Discomfort with passive weightbearing on R leg. Periodontal disease with dark discoloration and active bleeding. DIFFERENTIAL DIAGNOSIS: Septic Joint, Osteomyelitis, Leukemia, Fracture, Nonaccidental Trauma, Scurvy TESTS AND RESULTS: HSCRP 0.4, ESR 26, lead 1.3, CMP grossly wnl, prealb 15, iron 11, TIBC 507, % sat 2, ferritin <5, Marked microcytosis, Wbc 12.7, Hbg 8.8, Hct 28.6, plts 361, 64% neut, 5% mono, 3% eos, 6% mononuclear atypical lymphs, MCV 52.3, RDW 23, retic 23.7(ref 28-36), Urine and blood cultures -no growth.Skeletal survey: healing proximal R humerus fracture. R Knee radiographs: Edema in the soft tissues of knee, possible minimal periosteal reaction at distal R femur metaphysis. No linear lucency. Blood pool scan: increased uptake over the R ankle and distal R femur. Gallium scan-wnl.The patient was readmitted 2 wks later for refusal to bear weight on the L leg. L leg radiographs, blood pool scan, gallium scans -wnl. Vitamin C <0.1 (ref 0.4-2) FINAL WORKING DIAGNOSIS: ScurvyTREATMENT AND OUTCOMES: A long leg cast was placed for presumed healing R femur fracture. DCF cleared JN to return home. 2 wks later, JN was readmitted for refusal to bear weight on the L leg. Amino-acid based formula was initiated. He received 1 week inpatient ascorbic acid supplementation. He was discharged on Poly-Vi-Sol. He was pulling to a stand and crawling. Approximately 1 wk later, he ambulated without limp. Periodontal disease resolved thereafter. He returned to full toddler activity without symptom recurrence.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.