Background Primary hyperparathyroidism may present in a myriad of manners, varying from an incidental asymptomatic biochemical finding to gastrointestinal, psychiatric, renal, and bone manifestations. While hyperparathyroidism remains a rare diagnosis in the pediatric population, the initial approach to diagnosis and management of hypercalcemia in children is imperative for the general pediatrician. Herein, we describe an adolescent who presented with a lytic bone lesion and severe, symptomatic hypercalcemia due to primary hyperparathyroidism. Case presentation A 14-year-old male presented with vomiting, constipation, abdominal pain, and lethargy. He had an elevated total corrected calcium of 4.3 mmol/L. He was found to have a large pelvic lytic tumor consistent with a brown tumor due to primary hyperparathyroidism. He received pharmacologic therapy for stabilization of his hypercalcemia, including intravenous saline, intravenous bisphosphonates, and calcitonin. He subsequently received definitive therapy via parathyroidectomy and his post-operative course was complicated by hungry bone syndrome. Long-term follow-up has found full resolution of the lytic lesion and restored calcium homeostasis. Conclusions We present this case to highlight the possible presentations of hypercalcemia and hyperparathyroidism that are essential for a general pediatrician to recognize to ensure prompt diagnosis and management. Evaluation for hypercalcemia should be considered in patients with suggestive symptoms and physical exam findings. To our knowledge, this patient represents the first reported pediatric case of a pelvic brown tumor in an adolescent. While the multi-systemic complications of hyperparathyroidism may be quite severe, swift and appropriate management may mitigate these clinical outcomes.
Background: Invasive streptococcus pyogenes infections are rarely seen in healthy children. The multifocal nature of the following case is unusual and presents a diagnostic and therapeutic challenge for the treating physician. Case presentation: In this case report, we discuss an otherwise healthy 11-year-old boy with a multifocal invasive streptococcus pyogenes infection presenting with a myriad of musculoskeletal complications at distant sites. He suffered from multiple abscesses, septic arthritis of sternoclavicular joint and multiple sites of osteomyelitis, osteitis and tenosynovitis in the neck hand and foot. A significant course of intravenous antibiotic therapy was required for resolution of disease.Conclusions: Streptococcus pyogenes is a common culprit in head and neck infections. This case is unique because of the multifocal nature of our patient’s infection. The Otolaryngologist – Head and Neck Surgeon should acknowledge the potential for rare and diffuse complications from invasive streptococcus pyogenes infection.
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