This 14-year-old girl presented with a six-month history of amenorrhea, 9-kg weight loss, and a recent onset of back pain and fever to 38.9 °C. Four months prior to being admitted to the hospital, she had experienced the onset of a recurrent cough. A diagnosis of pneumonia was made and the condition was treated with an unidentified antibiotic.
The patient was a thin, pale girl with expiratory wheezes and nonlocalized abdominal tenderness. Laboratory studies showed a microcytic, hypochromic anemia with the following laboratory values: hematocrit, 26.6%; WBC count, 10,000/cu mm, with a normal differential cell count; and an ESR of 67 mm/hr. Serum electrolyte values and results of hepatic, renal, and bone marrow studies were normal. Blood and urine cultures, febrile agglutinins, fungal skin tests, and serology tests were negative.
A chest roentgenogram (Fig 1) and a computed tomographic examination of the chest, including the upper abdomen (Fig 2), were
Seibert JJ, Sandefur B, Jimenez JF, Young LW. Radiological Case of the Month. Am J Dis Child. 1985;139(1):101-102. doi:10.1001/archpedi.1985.02140030107043