Case 1: New-Onset Morning Vomiting and Ataxia in a 6-year-old Girl with Developmental Delay.

1. Rebecca Steuart, MD*,§ 2. Christopher Blunden, MD† 3. Camilia Kamoun, MD* 4. Lisa E. Herrmann, MD, MEd‡,§ 1. *Department of Pediatrics, 2. †Division of Endocrinology, and 3. §Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 4. ‡Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH Vomiting is a common complaint, yet the causes are not always so common, as some of the following cases illustrate. Philip R. Fischer, MD Associate Editor, Index of Suspicion A 6-year-old girl with a history of microcephaly and global developmental delay is admitted to the general pediatric inpatient service with increasing frequency of early-morning vomiting. Her mother states that the patient has had daily vomiting for 3 weeks. During this time she has developed irritability and a wide-based gait and is reported to be crawling more. She has no abdominal pain or diarrhea and no history of fevers or night sweats. Her parents note slow gross motor developmental progress with therapies, but no regression. Additional history reveals long-standing constipation and loud snoring with sleep, as well as significant and rapid weight gain of 18.3 lb (8.3 kg) in 12 months (Fig 1A), with a body mass index at the 98.5 percentile (Fig 1B). At the same time, linear growth has slowed, crossing percentiles from 60% to 19% over 12 months (109–112 cm) (Fig 1C). On medical record review, results of previous genetic testing and brain magnetic resonance imaging (MRI) obtained at 1 year 9 months of age were normal. Figure 1. The patient’s growth charts demonstrate rapid weight gain (A), the development of severe obesity (B), and declining linear growth velocity (C) over 12 …