Pediatric Annals

CME Article 

A 17-month Infant with a Calf Lesion and Generalized Hypotonia

Helkha Peredo-Pinto, MD; Norman M. Jacobs, MD

Abstract

A 17-month-old girl presented with a right calf lesion that had grown throughout 4 months and motor delay that had been present for 2 months. One week before admission, she also had anorexia and was irritable, but she had no fever. On admission, she had a temperature elevation to 100.7° F, and then she remained afebrile. She was well-nourished and not acutely ill but had generalized hypotonia and ataxia. There was a circular, indurated, dark red, 2.5-cm lesion on her right calf (see Figure 1) and two smaller subcutaneous, non-pigmented lesions on her left calf. The remainder of the physical examination was normal, including no hepatomegaly, splenomegaly, lymphadenopathy, or other focal neurologic findings. An ophthalmologist found no lesions in the optic fundi.

ABOUT THE AUTHORS

Helkha Peredo-Pinto, MD; and Norman M. Jacobs, MD, are with the Pediatrics Department, John Stroger Jr. Hospital of Cook County, Chicago, Illinois.

Address correspondence to: Helkha Peredo-Pinto, MD, Pediatrics Department, John Stroger Jr. Hospital of Cook County, 1901 W. Harrison St., 4th Floor, Suite #4806, Chicago, Illinois 60612; fax 312-864-9717; or e-mail: helkha@hotmail.com.

Dr. Peredo-Pinto and Dr. Jacobs have disclosed no relevant financial information.

EDUCATIONAL OBJECTIVES

  1. Review the pathogenesis of CNS tuberculoma and similarities with tuberculous meningitis.
  2. Discuss the appropriate diagnostic evaluation of a patient with suspected CNS tuberculosis.
  3. Determine the most effective therapy for a patient with extrapulmonary tuberculosis.

Abstract

A 17-month-old girl presented with a right calf lesion that had grown throughout 4 months and motor delay that had been present for 2 months. One week before admission, she also had anorexia and was irritable, but she had no fever. On admission, she had a temperature elevation to 100.7° F, and then she remained afebrile. She was well-nourished and not acutely ill but had generalized hypotonia and ataxia. There was a circular, indurated, dark red, 2.5-cm lesion on her right calf (see Figure 1) and two smaller subcutaneous, non-pigmented lesions on her left calf. The remainder of the physical examination was normal, including no hepatomegaly, splenomegaly, lymphadenopathy, or other focal neurologic findings. An ophthalmologist found no lesions in the optic fundi.

ABOUT THE AUTHORS

Helkha Peredo-Pinto, MD; and Norman M. Jacobs, MD, are with the Pediatrics Department, John Stroger Jr. Hospital of Cook County, Chicago, Illinois.

Address correspondence to: Helkha Peredo-Pinto, MD, Pediatrics Department, John Stroger Jr. Hospital of Cook County, 1901 W. Harrison St., 4th Floor, Suite #4806, Chicago, Illinois 60612; fax 312-864-9717; or e-mail: helkha@hotmail.com.

Dr. Peredo-Pinto and Dr. Jacobs have disclosed no relevant financial information.

EDUCATIONAL OBJECTIVES

  1. Review the pathogenesis of CNS tuberculoma and similarities with tuberculous meningitis.
  2. Discuss the appropriate diagnostic evaluation of a patient with suspected CNS tuberculosis.
  3. Determine the most effective therapy for a patient with extrapulmonary tuberculosis.

A 17-month-old girl presented with a right calf lesion that had grown throughout 4 months and motor delay that had been present for 2 months. One week before admission, she also had anorexia and was irritable, but she had no fever. On admission, she had a temperature elevation to 100.7° F, and then she remained afebrile. She was well-nourished and not acutely ill but had generalized hypotonia and ataxia. There was a circular, indurated, dark red, 2.5-cm lesion on her right calf (see Figure 1) and two smaller subcutaneous, non-pigmented lesions on her left calf. The remainder of the physical examination was normal, including no hepatomegaly, splenomegaly, lymphadenopathy, or other focal neurologic findings. An ophthalmologist found no lesions in the optic fundi.

ABOUT THE AUTHORS

Helkha Peredo-Pinto, MD; and Norman M. Jacobs, MD, are with the Pediatrics Department, John Stroger Jr. Hospital of Cook County, Chicago, Illinois.

Address correspondence to: Helkha Peredo-Pinto, MD, Pediatrics Department, John Stroger Jr. Hospital of Cook County, 1901 W. Harrison St., 4th Floor, Suite #4806, Chicago, Illinois 60612; fax 312-864-9717; or e-mail: helkha@hotmail.com.

Dr. Peredo-Pinto and Dr. Jacobs have disclosed no relevant financial information.

EDUCATIONAL OBJECTIVES

  1. Review the pathogenesis of CNS tuberculoma and similarities with tuberculous meningitis.
  2. Discuss the appropriate diagnostic evaluation of a patient with suspected CNS tuberculosis.
  3. Determine the most effective therapy for a patient with extrapulmonary tuberculosis.

10.3928/00904481-20080201-06

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