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INDEX OF SUSPICION

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.

We invite readers to contribute case presentations with discussions.

Case 1 Presentation

You are asked to see a 13-y-old boy who has been ill for 2 days with fever, headache, and a rash on his arms and legs. Previously in good health, he has had no exposure to others with such symptoms. On examination, he does not appear sick. His temperature is 101°F (38.3°C), but there are no other abnormal findings except for the rash, which consists of distinct erythematous macules on the distal arms and legs and the dorsa of both feet. A test for streptococci is negative and antipyretics are prescribed.

The fevers continue to occur daily, often to 103 to 104°F (39.4 to 40°C), sometimes with chills and sometimes with headache. By the ninth day of illness he has lost 5 lb.