Articles

Rickets on the Rise: A Case Series Highlighting the Importance of Growth Monitoring and Nutritional Assessment in Preventing Rickets

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Nutritional rickets, though a preventable condition, continues to show an increased incidence in clinical practice. It is crucial to recognize these cases during early stages in order to prevent the progression from vitamin D deficiency to clinical rickets, with the potential for irreversible complications. This case series describes five pediatric patients in which vitamin D deficiency and rickets was identified by close observation through growth monitoring and nutritional assessment. These workups were conducted due to the initial presentation of failure to thrive in each of these cases, prompting further evaluation to identify the underlying causes of growth faltering. A common theme throughout was normocalcemia, however, it is important to understand that this finding does not rule out the potential for rickets, as both subclinical rickets and stage two compensatory rickets can lead to normal laboratory findings. Therefore, growth faltering should always prompt nutritional assessment because early recognition, growth monitoring, a well-balanced diet with calcium-rich foods, compliance with vitamin D supplementation, and consistent follow-ups are essential to prevent the risk of developing clinical rickets.

When a Hemangioma is not a Hemangioma: Diagnostic Challenges in Infantile Soft Tissue Masses

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Infantile fibrosarcoma’s are the most common soft tissue sarcomas in infants under the age of one, and also have an excellent survival rate. However, these tumors also have a propensity to grow rapidly, and as such, require prompt evaluation and intervention to avoid negative outcomes, such as increased local invasion, more extensive surgical resections or amputations, as well as the potential risk for distant spread. This case report describes the presentation of an infantile fibrosarcoma that was initially misdiagnosed as an infantile hemangioma. Two conditions that can present very similarly in both clinical and radiologic evaluation, but require very different treatment strategies. Through our case presentation, we aim to highlight the importance of vigilance and accuracy during diagnostic work-up to ensure swift intervention for patients with potentially sinister underlying diagnoses.

The Importance of Diagnostic Vigilance Amid Cultural Barriers in Pediatric Oncology: A Case of Atypical B-ALL

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Pediatric cancers have the ability to spread rapidly, however, they also respond well to chemotherapy, and can have incredible success rates when diagnosis and intervention are implemented early. This case report describes an unusual presentation of B-ALL in a patient whose treatment was initially delayed due to barriers of cultural origin. The child initially presented with high fevers and vomiting, with mild abdominal distention and tenderness. With concern for sepsis or the need for surgical intervention, the pediatrician urged the family to proceed to a tertiary care center for further workup. The family felt these processes were unnecessary and felt that he would recover at home with over-the-counter medications. As the boy remained ill, emergency care was sought, and further investigations revealed a diagnosis of B-cell acute lymphoblastic leukemia. With this case report, we examine the importance of diagnostic vigilance amongst physicians to ensure a prompt and accurate diagnosis, while remaining mindful of cultural factors that may complicate clinical assessment and compliance.

Failure to Thrive in an 18-Month-Old Female Infant with Rickets: A Case Report

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: Undetected vitamin D deficiency can lead to severe complications such as Rickets in infants. This case report describes an unusual case of an 18-month-old female infant who presented with failure to thrive early in infancy and was later diagnosed with Rickets. The infant initially presented with failure to thrive, labs were ordered, and findings demonstrated low 25-hydroxyvitamin D and elevated alkaline phosphatase. Radiographic imaging of the knee was ordered and showed transverse sclerotic metaphyseal bands involving the distal femoral metaphysis and portion of the proximal tibial metaphysis, findings consistent with untreated rickets. A thorough investigation was conducted to determine the primary cause of the vitamin D deficiency, identifying the primary cause as nutritional deficiency. Per endocrinology, the patient was started on cholecalciferol 800 IU daily with dietary changes. This case emphasizes the importance of checking vitamin D levels in all pediatric patients who present with failure to thrive.