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Picture of the Month—Quiz Case FREE

Alfredo Salinas, MS; Cesar Escamilla, MD; Gerardo Rivera, MD; Hector R. Martinez, MS
[+] Author Affiliations

Author Affiliations: Departments of Pediatric Dentistry (Messrs Salinas and Martinez) and Basic Sciences (Drs Escamilla and Rivera), University of Monterrey, San Pedro, Mexico.


SECTION EDITOR: SAMIR S. SHAH, MD, MSCE


Arch Pediatr Adolesc Med. 2012;166(7):657. doi:10.1001/archpediatrics.2012.189a.
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A 16-year-old girl presented with a 3-week history of gingival pain and inflammation; mastication exacerbated the pain. She denied having experienced bleeding, rash, or fever. At the age of 1 year, the patient had a developmental hip dislocation that required surgical treatment.

Physical examination revealed a generalized tan pigmentation of the skin, micrognathia, microcephaly, the absence of the fifth finger on both hands, and growth retardation (height, 138 cm; weight, 26 kg; below the third percentile). An oral examination revealed prolonged retention of deciduous teeth and noneruption of permanent teeth, patchy brown discoloration of the tongue (Figure 1), and brown gums with smooth surface texture and generalized inflammation (Figure 2). Laboratory studies revealed a hemoglobin level of 8 g/dL (normal range, 11.0-16.0 g/dL [to convert to grams per liter, multiply by 10.0]), a mean corpuscular volume of 100 μm3 or more (to convert to femtoliters, multiply by 1.0), a neutrophil count of 1100/μL (normal range, 2000-8030/μL [to convert to ×109/L, multiply by 0.001]), and a platelet count of 35 000 × 103/μL (normal range, 150 000-300 000 × 103/μL [to convert to ×109/L, multiply by 1.0]). A panoramic dental radiographic scan shows the noneruption of permanent teeth (Figure 3). The bone marrow biopsy confirmed marrow hypoplasia.

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Graphic Jump Location

Figure 1. Photograph revealing small pigmented areas of the tongue of a 16-year-old girl.

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Graphic Jump Location

Figure 2. Photograph showing brown abnormalities of the gums of a 16-year-old girl.

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Graphic Jump Location

Figure 3. Panoramic dental radiographic scan showing the unerupted teeth of a 16-year-old girl.

Figures

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Graphic Jump Location

Figure 1. Photograph revealing small pigmented areas of the tongue of a 16-year-old girl.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Photograph showing brown abnormalities of the gums of a 16-year-old girl.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Panoramic dental radiographic scan showing the unerupted teeth of a 16-year-old girl.

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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.
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