Anal rash, blood in stools. ANA positive, blood work shows lupus. History of pseudopheochromocytoma. Treatment?
Patient: My daughter has a red rash like anal ring around her anys. There was blood on her toilet paper after she wiped There was blood in the stool and it burns her just laying down. She is ANA positive but no one currently can figure out what she has She has been tested for just about everything but blood work never shows a positive lupus or other rare ones. We are off to mayo in mid July but she can go out in the sun from 10-4 she can t handle heat and has been diagnosed with pseudopheochromocytoma ? What can I do to help her she is only 5! Doctor: Hello Dimokry At the outset I can assure that you are not alone. There are several dedicated doctors who would like to help you. When we do not know what is exactly wrong with our child we need to think from 7 angles 1. What is the problem? 2. Why it would have come? Hereditary/ infection / allergy 3. What are the tests required? Painful and painless tests. Scans. We have done several investigations. Do they need to be repeated again and again 4. What are the drugs child require? Should they have to taken daily like diabetic drugs or as and when required, like acetaminophen? 5. What are special diet the child will require?  6. Apart from drugs and diet what are precaution one has to take at home? 7. Lastly, how will be her future? Should we do anything to-day to safeguard her future.  Now let us one at a time. ANA positive does not mean anything serious. It just suggests your child MAY require further investigations. If you have done them, be reassured. Regarding ? pseudopheochromocytoma: you have not mentioned about Documented hypertension Documented tachycardia ( fast hear rate ) Abdomen scan ruling out adrenal tumours Importantly response to adrenergic blocking drugs This would be helpful. ?pseudopheochromocytoma is not diagnosed just like that. please add more details. Regarding blood in the stools can occur in several conditions. Anus redness is can happen in several conditions ranging from milk allergy to dust allergy (atopic disorders). Was there any frank bleeding from rectum? Has she had any rashes in her skin. there is another way to proceed. Check her weight ( atleast 16 to 18 kg) Height ( 99 to 105 cms) Head ( more than 47cm ) Chest ( more than the head ) Mid arm circumference ( 15 cms) If her growth is in this range means there could be nothing serious. Regarding exhaustion, what was her hemoglobin level. That could explain. Give her small frequent fluid diet. Be with her. Parents warmth can do wonders. Regularly post the progress.  Before going to mayo, try to document her course in the last 8 weeks. Problems, duration, drugs given, response to drugs Regarding the tests you have done classify them as 1. Basic tests 2. Biochemical tests 3. Imaging studies. If you have any problem, post in the public forum.we will happy to help you. with warm regards arulalan