San Gabriel Saniano Santos, J Santos, S Sison Sorreda Sotalbo PEDIA SGD San Gabriel Saniano Santos, J Santos, S Sison Sorreda Sotalbo

Patient Profile MP 13 years old Female Second year high school student Nagcarlan, Laguna

History of Present Illness 13 yrs PTC Pt was born term, SVD, in a hospital, assisted by MD, to then 23 year-old G6P1 (1051) female. No fetomaternal complications. Pt was noted to have hyperpigmented patch on Right anterior lower extremity. No pruritus, no tenderness, no paresthesia. Progression of the patch was slow to be even noticeable.

History of Present Illness 6 years PTC While riding a bike, Pt fell from the bike and hit the ground with her Right femur. Pain on Right hips and medial knee Pt was seen at UERM and casting was done. After the removal of the cast (2 weeks post-injury), Pt noted that the hyperpigmented patch has enveloped the entire Right lower extremity and has become darker. No pruritus, no tenderness, no paresthesia.

History of Present Illness 3 yrs PTC Pt noted that the Right lower extremity patch has become boggy and nodular.

History of Present Illness 2 weeks PTC 12 PM Pt slipped on a rag containing floorwax. Pt hit the cement floor with her Left calf and Right hips. The left calf was not painful, but the Right hips has VAS of 8/10. No open wound. No loss of consciousness. Pt was still able to stand and ambulate with a limp. Pt developed fever for 3 days, relieved by Paracetamol/Ibuprofen intake. Pt sought a “hilot”, but no relief of pain.

History of Present Illness 8 days PTC Due to the persistence of the pain on the Right hip, Pt sought consult at PGH-ER.

Past Medical History 2003: Fracture, Right femur Primary Complex (PTB?), treated for < 6 months

Review of Systems (paisa-isa na lang tong part na to. e/n naman ung pt except for difficulty on ambulation.) Emphasize especially NF-related findings

Family History (+) Diabetes Mellitus (+) Hypertension (+) Kidney disease (+) Hemophilia – father’s side (+) PTB No history of similar presentation

Personal and Social History Second year high school student Average scholastic standing Plays badminton No menarche yet Eldest of 3 siblings Lives with parents and siblings

Birth and Developmental History Pt was born to a G8P3 (3053) Planned and anticipated pregnancy with regular prenatal check-up, after following 5 consecutive abortions No fetomaternal complications Speech, fine motor, gross motor, cognitive, and social skills : At par with age Prior to the injury, Pt is a student and a badminton player

Physical Examination General Awake, conscious, coherent, not in cardiorespiratory distress, ambulatory with unilateral axillary crutch Vital Signs BP 110/70 HR 88 RR 24 Temp 37.4 C HEENT Pale conjunctivae, anicteric sclerae, (-) tonsillopharyngeal congestion, (+) multiple hyperpigmented macules/café au lait spots in circumoral distribution, midline trachea, (-) cervical lymphadenopathy Pulmonary Symmetrical chest expansion, normal tactile fremitus, normal breath sounds, (-) wheeze/rhonchi/crackles Cardio Adynamic precordium, normal rate and regular rhythm, no murmurs Abdomen Soft and flabby abdomen, multiple café-au-lait spots, normoactive bowel sounds, no tenderness on palpation, liver edge not palpable

Physical Examination Extremities Multiple hyperpigmented macules/café au lait spots at the back, Right forearm, Left palm, Left posterior leg 7 x 3 cm café au lait spot, Right elbow Two 2x2 cm café au lait spots, lower back Right lower extremity: hyperpigmented, boggy, hairy patch from ankle to inguinal area, with diffuse nodularity, (+) tenderness on nodule on medial knee Right hip: (+) bony deformity, (+) pain Full ROM for Upper extremities and Left lower extremity and Right foot. Right hip and knee ROM not assessed.

Physical Examination Neurologic Cranial nerves I-XII : Intact MMT : 5/5 for all extremities except Right lower extremity which was not assessed Sensory: insensate/0% sensation in all café au lait spots variable sensation in Right lower extremity (0-30%) Reflex : +2 for all

Diagnosis Pathologic fracture Secondary to Neurofibromatosis 1 (?)

NF notes to follow in a while Ikaw na lang bahala sa compilation *wink Pasend na rin ng final compilation para makita ko rin, thanks!