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Picture of the Month—Quiz Case
Isabel Castro Esteves, MD;
Pedro Fernandes, MD;
José Gonçalo Marques, MD
Arch Pediatr Adolesc Med. 2009;163(9):863.
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A 13-year-old girl, born in São Tomé and Príncipe, a country off the western coast of Africa, presented to our hospital with an ulcerated cutaneous lesion measuring 6 x 4.5 cm below her chest (Figure, A). The ulcer was first noted 8 months earlier. She underwent surgical drainage and several courses of intravenous antibiotics, without improvement. In addition to the cutaneous ulcer, physical examination revealed mild kyphosis and mild lower extremity weakness, which prompted gait discoordination attributable to decreased strength, as there was no other evidence of ataxia in the neurologic examination.
Figure appears in full text version.
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Figure. A, Photograph showing initial ulcer beneath the patient's chest on the left side. B, The chest radiograph demonstrated erosion of the superior border of the left fifth rib (white arrow), mild enlargement of the superior mediastinum, and decreased second thoracic vertebral height (black arrow). . . . [Full Text of this Article]
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Author Affiliations: Child and Family Department (Dr Esteves), Orthopedics and Traumatology Department (Dr Fernandes), and Pediatric Infectious Diseases Unit, Child and Family Department (Dr Marques), Hospital de Santa Maria, Lisbon, Portugal.
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Picture of the Month—Diagnosis
Arch Pediatr Adolesc Med. 2009;163(9):864.
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