A 15-Year-Old Girl With Steatorrhea Who Can’t See at Night

Jaime Shalkow, MD; Mayela E. García

Disclosures

November 13, 2019

Physical Examination and Workup

Upon physical examination, her height is 5' 2", weight is 98 lb, blood pressure is 108/70 mm Hg, pulse is 70 beats/min, and respiratory rate is 12 breaths/min. She is an alert and comfortable-appearing young lady in no acute distress. Head and neck examination findings show pale conjunctiva with no scleral icterus. Visual acuity test with a Snellen chart is 20/40, and she reveals prolonged time to visual adaptation in the dark. Funduscopic examination findings are normal. She is well hydrated. Her lungs are clear to auscultation bilaterally, and her heart sounds are normal, with no audible murmurs, rubs, or gallops.

The patient has a mildly distended but soft abdomen, with hyperactive bowel sounds heard in all four quadrants. No pain or masses are noted. A rectal examination reveals tan, guaiac-negative stool, with frank steatorrhea and mild creatorrhea. An area of ecchymosis is seen on the right thigh. No neurologic deficits are noted.

The rest of the physical examination findings are normal. A complete blood cell count reveals macrocytic anemia, and the prothrombin time is prolonged. The metabolic profile shows mild hypoalbuminemia. No other abnormal laboratory test results are present.

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