A Young Cuban Bruiser Walk through this case of unexplained bruising in a young boy that proves signs and symptoms are not always what they appear to be. An odd case of unusual bruising...
A 7-year-old boy presents with unexplained bruising, a potential sign of malignancy.
Let's proceed with a thorough medical history.
The young boy was well until 4 days prior to evaluation, when bruises began to appear.
No past bruising, nosebleeds; change in platelets from 45,000 ~4-5 days ago to 245,000--CBC normal. Vitals, WNL; active, well nourished.
Note linear hyperpigmentation without petechiae or purpura; no hepatosplenomegaly.
Not bruising; rather discolored linear and whorled hyperpigmentation including denuded area (arrow) that resembles a burn.
Linear hyperpigmentation on forearms; oddly shaped discoloration on the abdomen.
This is not leukemia; "bruising" pattern appears as though skin has been smeared with something.
Lesion pattern on abdomen appears to be a hand print?
Are there fruit trees near the home? What kind? Do children play with the fruit?
Lime juice smeared on the skin that leaves a mark could be identified as: a drug reaction; a yet-to-be-determined hematologic disorder; phytophotodermatits.
Furocoumarins (psoralens), present in wide variety of plants react with sunlight, causing a photosensitive reaction.
A wide variety of plants contain psoralens.
The next case was initially suspected to be one of child abuse.
A young boy presents for evaluation of unexplained burns; child protection team was called.
Immediately suspicious for lime juice or other psoralen-rich substance.
Mother had handled child numerous times while preparing pie made with limes.
Erythema at first appears unusual.
Re-enactment of the mother's recent behavior with the child demonstrates a perfect match. Another case of phytophotodermatitis related to limes!
Time to brush up with a look back at your Hurwitz Textbook of Pediatric Dermatology?
The slides above present 2 very interesting cases where presenting signs were not at all what they appeared to be. Dr Jonathan Schneider provides a compact lesson in diagnostics with a flash-back to his early days in medicine.Â