Teaching Cases - American Society of Hematology


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Teaching Cases

Childhood Acute Leukemia – James Harper, MD
Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE

I. History	II. Physical Exam	III. Laboratory Data	IV. Pathophysiology
V. Differential Diagnosis	VI. Prognosis/Clinical Course	VII. Teaching Points	VIII. Bibliography

I. HISTORY

Patient Presentation

A 17-month-old male is admitted to the hospital with a two week history of fever (T max 104) and a two day history of rash on his legs. Ten days ago, his primary care physician treated him with a 7 day course of Ceftin for a presumptive diagnosis of otitis media. Upon follow-up visit, it was found that he was still febrile and required ibuprofen nearly daily to control fevers. It was also found that he had lost weight, presumed to be due to decreased appetite.

What questions pertaining to the present illness are most relevant at this point?

Rash

	Can you tell me where the rash started?
	Does the rash blanch?
	Has the rash changed in appearance since you first noticed it?
	Has he been trying to scratch the rash?
Fever
	Did the fever improve with the antibiotics?
	Does the fever come on during particular times in the day?
	Has he had antibiotics in the past?
	Has he been in contact with other children or adults who are sick?
Weight Loss/Activity Level
	When did you first notice that he had lost weight?
	How much weight has he lost?
	What kind of diet does he eat?
	Have there been changes in his diet?
	Have there been changes in his activity level?

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