Pediatric Annals

Firm Rounds 

A 16-year-old Girl with Abdominal Pain, Cough, Vomiting

Robert Listernick, MD

Abstract

This 16-year-old girl was admitted for 4 days of abdominal pain, cough, and vomiting. She was seen by her physician at the start of her illness and started on Zithromax and Zantac. Due to persistent abdominal pain, she was seen at an outside emergency room. There was no history of diarrhea, hematemesis, or bilious emesis. Her past history was remarkable in that she had anemia since childhood without any definitive therapy having been given. Her menses started at age 14. She had menstrual periods every 2 to 4 months, and she used one pad per day without heavy bleeding. The family history was remarkable in that an older brother had had stomach surgery; no further information was available. The family had emigrated from Cambodia 4 years previously.

Key Learning Points

  1. In an adolescent girl who is having abdominal pain, the physician must determine the sexual history and eliminate, usually by a combination of history, physical examination, and laboratory testing, two important possibilities — ectopic pregnancy and pelvic inflammatory disease.
  2. The differential diagnosis of mesenteric lymphadenopathy includes lymphoma and granulomatous infections such as tuberculosis.
  3. Castleman disease is a lymphoproliferative disorder of indeterminate etiology, also known as giant lymph node hyperplasia. It can present as a single, localized mass, which has a very good prognosis if resected. Alternately, there is a multicentric presentation, which carries with it significant morbidity and mortality. Either form can present with systemic or constitutional symptoms such as fever, weight loss, or night sweats. Common laboratory findings include anemia, hypergammaglobulinemia, hypoalbuminemia, and elevated inflammatory markers, such as ESR and C-reactive protein.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL

Abstract

This 16-year-old girl was admitted for 4 days of abdominal pain, cough, and vomiting. She was seen by her physician at the start of her illness and started on Zithromax and Zantac. Due to persistent abdominal pain, she was seen at an outside emergency room. There was no history of diarrhea, hematemesis, or bilious emesis. Her past history was remarkable in that she had anemia since childhood without any definitive therapy having been given. Her menses started at age 14. She had menstrual periods every 2 to 4 months, and she used one pad per day without heavy bleeding. The family history was remarkable in that an older brother had had stomach surgery; no further information was available. The family had emigrated from Cambodia 4 years previously.

Key Learning Points

  1. In an adolescent girl who is having abdominal pain, the physician must determine the sexual history and eliminate, usually by a combination of history, physical examination, and laboratory testing, two important possibilities — ectopic pregnancy and pelvic inflammatory disease.
  2. The differential diagnosis of mesenteric lymphadenopathy includes lymphoma and granulomatous infections such as tuberculosis.
  3. Castleman disease is a lymphoproliferative disorder of indeterminate etiology, also known as giant lymph node hyperplasia. It can present as a single, localized mass, which has a very good prognosis if resected. Alternately, there is a multicentric presentation, which carries with it significant morbidity and mortality. Either form can present with systemic or constitutional symptoms such as fever, weight loss, or night sweats. Common laboratory findings include anemia, hypergammaglobulinemia, hypoalbuminemia, and elevated inflammatory markers, such as ESR and C-reactive protein.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL

This 16-year-old girl was admitted for 4 days of abdominal pain, cough, and vomiting. She was seen by her physician at the start of her illness and started on Zithromax and Zantac. Due to persistent abdominal pain, she was seen at an outside emergency room. There was no history of diarrhea, hematemesis, or bilious emesis. Her past history was remarkable in that she had anemia since childhood without any definitive therapy having been given. Her menses started at age 14. She had menstrual periods every 2 to 4 months, and she used one pad per day without heavy bleeding. The family history was remarkable in that an older brother had had stomach surgery; no further information was available. The family had emigrated from Cambodia 4 years previously.

Key Learning Points

  1. In an adolescent girl who is having abdominal pain, the physician must determine the sexual history and eliminate, usually by a combination of history, physical examination, and laboratory testing, two important possibilities — ectopic pregnancy and pelvic inflammatory disease.
  2. The differential diagnosis of mesenteric lymphadenopathy includes lymphoma and granulomatous infections such as tuberculosis.
  3. Castleman disease is a lymphoproliferative disorder of indeterminate etiology, also known as giant lymph node hyperplasia. It can present as a single, localized mass, which has a very good prognosis if resected. Alternately, there is a multicentric presentation, which carries with it significant morbidity and mortality. Either form can present with systemic or constitutional symptoms such as fever, weight loss, or night sweats. Common laboratory findings include anemia, hypergammaglobulinemia, hypoalbuminemia, and elevated inflammatory markers, such as ESR and C-reactive protein.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL

10.3928/00904481-20080401-07

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