Category Archives: EMages Winners

2019 EMage Contest First Place Winner: Helluva Uvula

Evan Laveman, MD Emergency Medicine PGY3
Kelly Kelley, MSN, RN, CPNP, CNS
Christopher Redgate, MD, MS, PEM Fellow PGY6

Pediatric Emergency Department, Department of Emergency Medicine, Harbor-UCLA

16-year-old male with no past medical history presented to the Pediatric Emergency Department (PED) for 4 months of nasal congestion worsening over the past month. He immigrated from Honduras with his father 20 days ago and over this time noticed a decreased ability to breath through his nose. Most troubling, he started to develop foul smelling nasal discharge mainly through his left nare. His only medical contact had been at a U.S. clinic when he first arrived where he was prescribed a nasal spray and cetirizine with no relief. He felt moderate sinus pressure but denied weight loss, fevers, chills, headache or vision changes. read more

First Place: White Hair and Big Belly

Ryan J Reichert, MD, PGY3

Stephanie F Moses, DO PEM Fellow PGY6

Case Presentation:

6-day-old term Haitian male presented to the Emergency Department (ED) for abdominal distension. Per mother, the patient was born at home and delivery was uncomplicated. History revealed the patient was able to pass stool and urinate in the first day of life. He tolerated frequent breastfeeding until day of life 3 when he developed increased fussiness, feeding intolerance, and constipation without emesis. Abdominal distension developed and increasingly worsened over the next 48 hours. Although there were no prenatal medical visits, mother stated that there were no fevers or known infections during pregnancy. read more

Second Place: Generalized Flushing Followed by a Bulla

Patrick McLaughlin, MD, MS

Case Presentation

A three month old male born at 39 weeks gestation, with a history of a possible seizure disorder, presents two hours after a large fluid-filled lesion developed on his left forearm. Immediately before he developed this lesion his entire body became red and flushed for 15 minutes then spontaneously resolved. The fluid-filled lesion shown developed on top of a skin lesion that had previously been present since 1 week of life. At 2 months of age he experienced these exact symptoms for which he was hospitalized overnight at another institution. During that admission, the bulla’s fluid was cultured for bacteria but was negative for growth. He completed a 10 day course of oral clindamycin and topical mupirocin without resolution of the lesion. Family denies any fever, purulence from the lesion, sick contacts, burns, pets or changes in the patient’s behavior. read more

Third Place: Not Just Your Typical Newborn Rash

Matthew Cully, DO

Benjamin F. Jackson, MD

A three-day-old term female infant presented to the emergency department with a two-day history of rash to the back of her right leg. The family noticed the rash shortly after hospital discharge and described the rash first as just a few red spots. However, the following day, the rash spread on her right leg and was now described by the family as multiple red and fluid filled spots. No maternal history of herpes simplex virus (HSV) or varicella at time of delivery. The infant was otherwise well, afebrile with appropriate waking, alertness, a3rd Place Pic 1ppetite, voiding and stooling. On physical examination, she appeared well, active and in no acute distress. A linear, vesicular rash with surrounding erythema extended from right posterior mid shin to upper thigh (Image 1 and 2). Pediatric dermatology was consulted and a full neonatal sepsis evaluation including urine, blood and cerebrospinal fluid (CSF) was performed. read more

First Place Emage Winner: Her Skin is Cracking

Mary Claiborne, MD; Shilpa Dass, MD; Robert M Lapus, MD; Samuel J. Prater, MD

Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas

Children’s Memorial Hermann Hospital

Case Presentation:

11 year old African American female with trisomy 21, corrected congenital heart defect, and atopic dermatitis presented with generalized pruritus and scalinesss for 2-3 days. Mom has been putting petroleum jelly on the lesions, however because of the worsening appearance, she presented to the emergency department. read more