![]() The parents report that their daughter appears healthy and is doing well in first grade. Three months ago, the child, his parents, and his 6-year-old sister moved into a freshly painted house. Results of the neurologic examination are normal there is no muscular atrophy. He does not have point tenderness in his legs, and he has full range of motion in knees and hips. The oral pharynx and abdomen appear normal upon examination his lungs are clear. He is sweating, and his nose, fingers, and toes are erythematous the skin on his fingers and toes is peeling. He refuses to walk or stand and says that his legs “hurt.” He is afebrile, has a heart rate of 130 per minute and respirations of 16 per minute. The child’s immunizations are up to date, and he is on no medications.ĭuring physical examination, the boy is uncooperative and crying. His growth and development have been normal he is in the 90th percentile for weight and height. History reveals that the patient had recurring ear infections this past winter, which were treated with oral antibiotics. The child has had no other symptoms, such as a runny nose or cough, and has not lost weight. On those nights the child has felt warm, but his parents did not take his temperature. Recently, he has experienced night sweats. ![]() His parents note that about a month ago, he seemed to withdraw and become cranky. A 3-year-old boy with irritability, digital erythema, and leg painĪ 3-year-old boy is brought to your office by his parents, who state that the child refuses to play and prefers to lie on his bed.
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