The Blue Man: Pediatric Diseases with Implications for Adulthood

Blue discoloration of the skin and cartilage, or ochronosis, is a rare physical examination finding. Here are two cases of childhood onset ochronosis, one exogenous and one endogenous in etiology.

Perichondritis: inspect the lobule

Case presentation This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule. Diagnosis The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.

Common Neonatal Presentations

Parents of newborns, particularly first-time parents, are often concerned that their infant has a physical examination finding or behavior that is out of range of normal. Neonates have a variety of common findings and diagnoses specific to this age group. However, their range of behaviors is limited, and they are unable to communicate, complicating evaluation. Caring for neonates in the emergency department requires knowledge of newborn-specific conditions as well as the range of normal behaviors. Common chief complaints include jaundice, feeding difficulties, vomiting, irritability and crying, breathing difficulty, and rash. Emergency department providers must be familiar with the range of normal behaviors and common diagnoses seen in neonates. This chapter presents an overview of common concerns parents have about their neonates.