The most common malignancy in childhood is leukemia/lymphoma. | Paediatrics videos & books

The most common malignancy in childhood is leukemia/lymphoma. The most common solid tumors of childhood are CNS tumors, followed by neuroblastoma and Wilms tumors. (Rudolph et al., 2003, p. 1583) The mildly elevated WBC with lymphocyte predominance with the presence of “atypical” lymphocytes would indicate that his child most likely has acute EBV infection (infectious mononucleosis). This acute EBV infection is usually subclinical in younger children, but can be manifested by acute hemolytic anemia and splenomegaly. Testing for the diagnosis of EBV includes EBV DNA PCR and heterophile antibody response testing (monospot test). Diagnosis usually is made based upon serology testing for anti-EBV IgG and IgM levels. There is no specific therapy indicated for the acute EBV infections. (American Academy of Pediatrics, 2003, pp. 286–288) Acute Lyme disease is very uncommon in children. The early stages of acute Lyme disease is characterized by a distinctive rash (erythema migrans). This is then followed by a multiple annular rash of disseminated Lyme disease. Often seen in this stage is cranial nerve palsies, specifically a facial nerve (CN VII) palsy. Late Lyme disease is characterized by recurrent arthritis and arthralgia. Serologic testing is only recommended if there is a very high clinical index of suspicion, unlike this child. (American Academy of Pediatrics, 2003, pp. 428–433) Acute systemic-onset JRA (Still disease) can present in a child of this age in a nonspecific manner (i.e., fever of unknown origin). Children with Still disease will typically have dramatic elevations in acute-phase reactants (i.e., ESR). This child’s ESR being 5 would go against JRA. (Rudolph et al., 2003, pp. 480–481) SLE would be unexpected in a child of this age, specifically a male. There are no features of this vignette which would indicate the need for confirmatory testing in this child. Likewise, the low ESR would not be consistent with acute SLE. (Rudolph et al., 2003, pp. 486–489) TB presents in children mostly as acute lower respiratory tract infection or subacute lymphadenitis (scrofula). In infants, an aggressive meningitis is a global cause of significant morbidity and mortality. Acute hematogenous TB is not a condition seen in otherwise healthy children.