10-year-old female is brought by her parents with a chief complaint of thickened nails of her feet. The thickened nails have been present for over last 6 months and have not responded to topical ointments. Two visits to a podiatrist also failed to clear the problem although the nails did temporally improve after filing. Past Medical History: PMH is negative. Symptomatic review suggests tanned complexion and intermittent complaints of leg cramps. Leg cramps are quite painful but transient after rest and massage. Family history normal. No recent travel.
Physical Exam: VS T37, P80, R25, BP 90/70. Height and weight are both at the 50th percentile. HEENT, cardiac, pulmonary and abdominal exams are non-contributory. Breasts and genitalia are Tanner stage I. Neurological evaluation is physiologic and non-focal. Her complexion is well tanned even in areas that are not sun-exposed. Her…
