Vaginal Bleeding and Otorrhea in a 6-year-old Girl

摘要

A previously healthy 6-year-old girl presents with 9 days of left ear pain, 4 days of left ear drainage and fevers, and 1 day of vaginal bleeding. The patient's symptoms are unalleviated by amoxicillin and ofloxacin drops prescribed for presumed otitis media. The parents deny trauma, injury, or abuse. The family history is remarkable for a brother with short stature and hyponatremia requiring supplementation. Her vital signs are notable for tachycardia, and physical examination is remarkable for pallor and a poorly visualized left tympanic membrane secondary to copious purulent, blood-tinged material in the auditory canal. The patient is actively bleeding from the vaginal introitus, without signs of trauma.