HPV, ADHD, and a purpuric rash: This week’s pediatrics briefing

Welcome to issue 10 of The Differential: Pediatrics. Created by physicians for physicians, this high-quality pediatrics briefing is designed to be quick (skim it in just a few minutes) and thorough (all the information you need is in this email). Today’s Differential is edited by Dr. Daniel Flanders, a pediatrician and adjunct lecturer at the University of Toronto.

Single-Sentence Summaries

1. A mother’s obesity and diabetes increases the risk of her children developing ADHD, psychotic and mood disorders, and autism. Pediatrics, August 2018

2. HPV vaccination programs in the U.S. appear to be lowering the incidence of cervical cancer in young females. American Journal of Preventative Medicine, August 2018

3. One in seven fetal Zika virus exposures results in birth defects or neurodevelopmental abnormalities. CDC Morbidity and Mortality Weekly Report, August 10, 2018

4. Consumption of fast food appears to correlate with asthma in a dose-response pattern. Respiration, July 2018

5. A large systematic review and meta-analysis suggest that methylphenidate is the safest and most efficacious treatment for children with ADHD. Lancet Psychiatry, August 7, 2018

Clinical Quiz

A 3-year-old female presents to her pediatrician with a one-week history of abdominal pain and a rash. Her mother mentions that the rash developed following recovery from an upper respiratory tract infection and that she has also been complaining of knee pain. On examination, a purpuric rash is seen on her legs and feet. Urinalysis reveals hematuria and proteinuria. Which of the following is most likely to be associated with this patient’s condition?

A. Hypothyroidism

B. Hearing loss

C. Intussusception

D. Coronary artery dilatation

Answer at the bottom of this post, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl **The ‘ABCDEFG’ Differential Diagnosis for Short Stature **

Alone (neglected infant)

Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses)

Chromosomal (Turner’s, Down’s)

Delayed growth Endocrine (low growth hormone, Cushing’s, hypothyroid)

Familial GI malabsorption (celiac, Crohn’s)


C. Intussusception

This patient’s findings are suggestive of Henoch-Schönlein purpura (HSP), the most common pediatric vasculitis involving the small vessels of the skin, gastrointestinal tract, kidneys, and joints. The self-limiting condition is characterized by the classic clinical triad of purpura, abdominal pain, and arthritis. Intussusception is a complication of the condition and the most common surgical indication, occurring in approximately 3% of HSP patients. Acute or progressive abdominal findings should signal clinicians to investigate accordingly.

Published August 2018

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