Index of suspicion. Case 1: Nonbilious projectile vomiting in a neonate. Case 2: Fever, rash, headache, myalgia, and arthralgia in an 11-year-old boy. Case 3: Ecchymotic lesions on the backs of Asian boys.

摘要

A 16-day-old boy is evaluated in the ED for 5 days of projectile vomiting. Thirty minutes after breastfeeding, he vomits milk at distances up to 2 ft. He also has been having difficulty feeding, staying on the breast for only 5 minutes, and is sleepy. The frequency of emesis has been increasing to after almost every feeding. Urine output and stooling frequency have decreased.The infant was born at term to a 37-year-old G2P2 woman after an uncomplicated pregnancy. His newborn screening results were normal. He developed icterus on postnatal day 2, with a peak bilirubin value of 22 mg/dL (376.3 mumol/L) and a positive direct antiglobulin test. The hyperbilirubinemia responded to phototherapy within 24 hours.