Medical Mystery Solved - A Deficient Diagnosis | NEJM

This Double Take video from the New England Journal of Medicine presents the case
of a toddler with a limp. Based on a Clinical Problem-Solving article published
in the Journal, the video explores the differential diagnosis for a child refusing
to bear weight on his right leg and follows its evolution as new clinical findings
arise from the diagnostic evaluation.

For further reading, the following article, A Deficient Diagnosis (Hafez et al., in the April 7, 2016, issue) referenced in this video, is available
at www.nejm.org/doi/full/10.1056... .
The New England Journal of Medicine is the world’s leading general medical
journal. Continuously published for over 200 years, NEJM publishes
peer-reviewed research along with interactive clinical content for physicians,
educators, and the global medical community at NEJM.org.
#medicaleducation #clinicalmedicine #growthanddevelopment #pediatrics

[@dr.anuptoshniwal]

I am for India. Fortunately or unfortunately 40-50 seconds in history i suspected scurvy.. It can be a tricky diagnosis.. There is so much pain due to bone changes, that sometimes kids present with pseudo-paralysis. A very good and needed video specially who work in high end hospitals. It is also common in Cancer patients

[@ponsaravanan3749]

Me too sir.. i am also from india.. i am also suspected initially as scurvy only...

[@dariuslima]

The "picky eating" had me thinking what it could be...and i was surprised to see that it was scurvy. A thorough Anamnesis can go a long way, but understandable, since nowadays everything is fast...Amazing case! Thanks!

[@as-sabahossain9099]

Before going through all those invasive procedure, a simple nutritional assessment would have done it. I think more than the diagnosis, the important takeaway for video is to have in depth, detailed history to exclude all possible differentials.
Very much grateful for this wonderful presentation 🙏🙏

[@srinivasaraghavan_devpaed]

Scurvy must definitely be considered as a differential diagnosis of musculoskeletal symptoms in children with developmental needs. Especially if the child has picky eating, where child avoids fruits and vegetables

[@vishwakaran9020]

I love my teacher ...dr.Bhose ❤

[@sim_aware]

Very interesting case. Thanks!

[@absurdum-the-artist]

To me the possibility of scurvy felt possible from the very beginning. I and many other people with ASD were far too close to being in the same position

[@chrislongdc]

No offense but those were highly invasive procedures, and took way too long to come to that diagnosis. I don't see this as a win for medicine. Then again, a good reminder on what the child's diet consisted of was missed during the case history. A simple mistake.

[@sviaxqu4072]

upload more cases

[@shirmila9911]

Very interesting case- thank you so much for highlighting the occurrence of Vit C deficiency even in resource rich settings.
However, scurvy should have been in the differential from the beginning and an empiric trial of vitamin C would have spared this child from going through so many expensive and painful investigations.
With the advent of iOmics and precision medicine , treatment for even common conditions is likely to get extremely expensive.
Maybe case discussions in the future should also pause after H&P, and brainstorm possible treatment options if you had nothing further to go upon- ie. no further information from expensive investigations

[@maohrtega]

What image and video editing applications did you use?

[@ajitbirnale1971]

American way of diagnosis 😂

[@anantasaikia2344]

Thank you for reminding , nutritional deficiencies are very common in new generation, maybe attributable to altered dietary habits .

[@user-uv5ow9ps4c]

🎯 Key Takeaways for quick navigation:
00:07 🚑 *Presentación del caso y síntomas iniciales*
- Niño sano de dos años y medio con dificultad para cargar peso en la pierna derecha.
- Radiografía muestra posible fractura de peroné, preocupación por causas infecciosas, malignas, inflamatorias o neuromusculares.
- Desarrollo posterior de dolor en la pierna izquierda y síntomas gingivales, aumentando la preocupación por leucemia.
01:33 🏥 *Evaluación en el departamento de emergencias*
- Agitación y dolor en ambas piernas, sospecha de trauma no accidental.
- Pruebas muestran bajo nivel de hemoglobina, tamaño reducido de glóbulos rojos, y posible leucemia.
- Consideración de anemia por deficiencia de hierro o envenenamiento por plomo.
02:57 🧠 *Evaluación neurológica y complicaciones*
- Realización de resonancia magnética de cabeza y columna, descartando Guillain-Barré.
- Desarrollo de erupción cutánea y traslado a otro hospital para evaluación adicional.
- Exploración de posibles causas de parálisis en las extremidades inferiores, incluyendo la posibilidad de una picadura de garrapata.
04:23 🩹 *Exploración de otras posibles causas*
- Estudios serológicos para condiciones reumatológicas y deficiencias nutricionales.
- Resultados normales en pruebas de inflamación muscular y niveles de vitaminas.
- Reevaluación de radiografías y CT scans revela bandas metafisarias lucentes en el fémur.
05:46 🍊 *Diagnóstico final y tratamiento*
- Diagnóstico de escorbuto por deficiencia de vitamina C.
- Inicio de suplementos de ácido ascórbico, mejoría en una semana.
- Importancia de la historia dietética detallada para un diagnóstico preciso.
Made with HARPA AI

[@tarunaikrar3383]

D/ Vit C Defiance