Case 1: Abnormal pain with weight loss
Z Bismilla | G Thompson | M Salvadori
Case 2: Why is he not 'thriving'?
Abdominal pain with
A five-year-old boy presented with decreased appetite and
abdominal pain. His growth had plateaued, with his weight
crossing from the 75th percentile to below the 50th percentile
and height crossing from the 90th percentile to the
75th percentile. He was found to be anemic with a hemoglobin
of 72 g/L. He was started on iron supplementation. His
abdominal pain continued on and off over the next
three years. An increase in the pain and frequency of his
bowel movements along with acute weight loss brought him
back for medical attention at the age of eight years. The
abdominal pain occurred before or during stooling, with some
relief afterward. He was having five mucousy, bloody bowel
movements per day and two to three per night. Tenesmus and
urgency were present. He had intermittent fevers and nausea
with occasional vomiting. His appetite was decreased and he
had lost 5 kg over three months.
Why is he not 'thriving'?
A 15-month-old boy was being investigated for failure to
thrive and hypotonia. He was born by cesarian section for
placenta previa at 36 weeks gestation to a 38-year-old mother.
Birth weight and height were below the third percentile,
while the head circumference was at the 25th percentile.
He required no resuscitation but hypotonia was noted at
birth. Apart from an episode of pneumonia at
nine months, he had been healthy. Weight gain had been
poor, plateauing at 10 months, even with a high caloric
intake of 195 cal/kg/day to 210 cal/kg/day. He still required
assistance to stand and was unable to crawl or sit unsupported.
Fine motor, verbal and social skills were intact. The
family history was noncontributory. Complete blood count,
electrolytes, renal and hepatic function, metabolic testing
and thyroid-stimulating hormone level were normal.
Imaging of the head and kidneys, nerve conductions and
muscle biopsy were all normal.