Case 2: Blindness and Loss of Gross Motor Skills in a Young Toddler

Whitney Rolling; Fernando Bula-Rudas; Carl S. Galloway; Vishnu Kanala; Geoffrey Tufty; Archana Chatterjee

doi:10.1542/pir.2017-0230

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Whitney Rolling, DO*
Fernando Bula-Rudas, MD*
Carl S. Galloway, MD*
Vishnu Kanala, MD*
Geoffrey Tufty, MD*
Archana Chatterjee, MD, PhD*

^*Department of Pediatrics, Sanford Children's Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, SD

AUTHOR DISCLOSURE
Drs Rolling, Bula-Rudas, Galloway, Kanala, and Tufty have disclosed no financial relationships relevant to this article. Dr Chatterjee has disclosed that she serves as site principal investigator on multicenter clinical trials funded by Merck, GlaxoSmithKline, and MedImmune; that she serves as a speaker for vaccines manufactured and distributed by Merck and Pfizer; and that she serves on the Pfizer advisory board for new vaccine development. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 16-month-old previously healthy girl is admitted to the hospital with concerns of gross motor regression and poor eye tracking. She had been able to walk independently but has not been able to do so for the past month. Her mother reports a possible viral illness that their entire family had consisting of 1 day with vomiting and diarrhea 1 month before her daughter’s admission. The illness resolved spontaneously for the rest of the family, but her daughter still has residual fatigue and crawls now instead of walking. The patient lives on a family farm, and the only animals there are outdoor barn cats. She was recently seen by her primary care provider, who ordered a complete blood cell count, which was significant for a white blood cell (WBC) count of 15,300/μL (15.3×10⁹/L) (reference range, 5,000–15,000/μL [5.0–15.0×10⁹/L]), a hemoglobin level of 12.1 g/dL (121 g/L) (reference range, 10.5–14.0 g/dL [105–140 g/L]), and a platelet count of 356×10³/μL (356×10⁹/L) (reference range, 140–400×10³/μL [140–400×10⁹/L]) with 19% neutrophils, 53% lymphocytes, 7% monocytes, 20% eosinophils, and 1% basophils. Because of her profound eosinophilia, she is referred to the pediatric hematology clinic. During this clinic visit the providers notice that she is …