RT Book, Section A1 Chauhan, Alia A1 Smith, Mindy A. A2 Usatine, Richard P. A2 Sabella, Camille A2 Smith, Mindy Ann A2 Mayeaux, E.J. A2 Chumley, Heidi S. A2 Appachi, Elumalai SR Print(0) ID 1114879285 T1 Hyperlipidemia and Xanthomas T2 The Color Atlas of Pediatrics YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 978-0-07-176701-9 LK accesspediatrics.mhmedical.com/content.aspx?aid=1114879285 RD 2024/03/29 AB A 5-year-old boy is undergoing a complete physical exam prior to starting kindergarten and the pediatrician notes some papules over the right Achilles tendon (Figure 193-1A). She also notes rings around the peripheral corneas of both eyes that could be arcus juvenilis (Figure 193-1B). The mom noticed the papules near the foot about 2 months ago but had not noticed anything unusual about the eyes. The pediatrician suspects that these findings could be secondary to elevated lipids and discovers that the mother has type 2 diabetes along with high cholesterol. The child is sent for a fasting lipid panel and blood sugar. The results confirm familial hypercholesterolemia (total cholesterol of 810 mg/dL and a low density lipoprotein of 507 mg/dL). The papules over the Achilles tendon are tendinous xanthomas and the eyes do show arcus juvenilis secondary to the elevated lipids. The child is referred to endocrinologist and the mother is told that all the family should be tested and everyone should be eating a low fat diet.