0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Picture of the Month—Quiz Case FREE

Jesleen Rana, BASc; Ahmed Alterkait, MBBCh; Michael Weinstein, FRCPC
[+] Author Affiliations

Author Affiliations: Queen's University, Kingston (Ms Rana) and Department of Pediatrics, The Hospital for Sick Children, Toronto (Drs Alterkait and Weinstein), Ontario, Canada.


SECTION EDITOR: SAMIR S. SHAH, MD, MSCE


Arch Pediatr Adolesc Med. 2012;166(5):479. doi:10.1001/archpediatrics.2011.1247a.
Text Size: A A A
Published online

A 12-year-old boy with nonverbal autism developed a 2-month history of petechiae and bruising followed by worsening musculoskeletal pain and refusal to walk. There was no preceding history of trauma, fever, or visible joint swelling. On physical examination he was pale and agitated. His lower limb range of motion was limited, and he maintained 90° flexion of both knees and external rotation of his left hip with refusal to ambulate. Petechiae and bruising were noted on his lower extremities (Figure 1), and gingival bleeding (Figure 2) and alopecia were noted. Investigations revealed microcytic anemia (hemoglobin level, 9.0 g/dL; reference range, 12.0-16.0 g/dL; to convert to grams per liter, multiply by 10.0), a low serum iron level, and normal white blood cell and platelet counts. The peripheral blood smear was normal apart from features suggestive of iron deficiency, and the erythrocyte sedimentation rate was elevated (46 mm/h; reference range, 1-10 mm/h). Radiographs of the legs demonstrated only soft-tissue swelling and osteopenia. Dietary history revealed longstanding restricted food preferences limited to yogurt, pasta, oatmeal, and water.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Bruising (large arrow) and perifollicular petechiae (small arrow) on the lower leg.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Diffuse gingival inflammation and bleeding (arrows).

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Bruising (large arrow) and perifollicular petechiae (small arrow) on the lower leg.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Diffuse gingival inflammation and bleeding (arrows).

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles