WHAT'S YOUR DIAGNOSIS?

By MELORI E. McDONALD, MSN, CPNP, STEPHANIE GOODSON, MD and VASUNDHARA TOLIA, MD | April 1, 2005

This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer responsible for the presentation of the article.

HISTORY

An 8-year-old boy seen at a gastroenterology clinic after "accidentally" swallowing 2 coins 4 days earlier. Had difficulty in breathing shortly after swallowing the coins and was taken to emergency department. X-ray films at that time demonstrated coins in his esophagus. Patient was immediately transferred to a tertiary care facility. Repeated x-rays showed the coins in his stomach. Patient was sent home with instructions to follow up with his pediatrician in 1 to 2 days.

Two days later, the pediatrician noted a generalized rash and became concerned about Stevens-Johnson syndrome. A course of oral corticosteroids was started. X-ray films showed coins still in the patient's stomach.

The patient was referred for GI evaluation and possible endoscopic removal of the coins.

PHYSICAL EXAMINATION

Alert afebrile patient in no apparent distress. Developmentally age-appropriate. Breath sounds, clear to auscultation; heart, regular rate and rhythm. Abdomen, soft, nondistended, and nontender to palpation. Rash generalized, erythematous, maculopapular, vesicular, and pruritic; more pronounced on patient's back, chest, and lower extremities. No mucosal involvement. No lymphadenopathy.