After becoming involved in a dispute with another kid at school, a 13-year-old boy is escorted to the office by his parents. According to his parents, "He has never been in a fight before, and we are concerned because his grades have also been falling. He appears irritated and grumpy, spends extended periods of time in his room, and no longer welcomes guests to his house." When asked about the event by himself, the patient answers, "The wall people told me that he was trying to poison my food." The patient has no substantial medical history; nevertheless, a paternal aunt has a family history of bipolar illness. The temperature is 37.2 degrees Celsius (99 degrees Fahrenheit), the blood pressure is 130/80 mm Hg, the pulse rate is 98 bpm, and the respirations rate is 14/minute. Physical examination shows a postural tremor on extension of the arms and a broad-based gait. Mental status examination is significant for slurred speech, sad mood, and distractibility. Laboratory studies reveal elevated serum transaminases. Which of the following is the most likely diagnosis?

Question

After becoming involved in a dispute with another kid at school, a 13-year-old boy is escorted to the office by his parents. According to his parents, "He has never been in a fight before, and we are concerned because his grades have also been falling. He appears irritated and grumpy, spends extended periods of time in his room, and no longer welcomes guests to his house." When asked about the event by himself, the patient answers, "The wall people told me that he was trying to poison my food." The patient has no substantial medical history; nevertheless, a paternal aunt has a family history of bipolar illness. The temperature is 37.2 degrees Celsius (99 degrees Fahrenheit), the blood pressure is 130/80 mm Hg, the pulse rate is 98 bpm, and the respirations rate is 14/minute. Physical examination shows a postural tremor on extension of the arms and a broad-based gait.  Mental status examination is significant for slurred speech, sad mood, and distractibility.  Laboratory studies reveal elevated serum transaminases.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Wilson disease is associated with copper accumulation in the liver, brain, and cornea.  It can present in childhood or adolescence with abnormal liver function tests and/or neuropsychiatric symptoms.  Psychiatric symptoms may predate other manifestations and include personality changes, depression, mania, and/or psychosis.

After Becoming Involved in a Dispute with Another Kid at School