INDEX OF SUSPICION
Bradley J. Bradford MD1
Harry S. Miller MD2
Walter L. Gilbert MD3
1 The Mercy Hospital of Pittsburgh, Pittsburgh, PA
2 The Children's Hospital at Albany Medical Center, Albany, NY
3 Eastern Virginia Medical School, Norfolk, VA
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
A 19-year-old girl comes to the university health service with complaints of difficulty swallowing and fever. The illness began 2 days ago with a minor sore throat. Although she has been able to take in sufficient fluids, she has had progressively more difficulty swallowing and has became febrile. There has been no known exposure to other illnesses, nor does she have any specific complaints of a chronic nature. Her last menstrual period was 3 weeks ago; she denies sexual activity.
Physical examination reveals a febrile young woman in no acute distress but complaining of throat discomfort. Pertinent findings include a markedly swollen oropharynx with erythema of the uvula and marked cervical adenopathy. The remainder of the examination is normal.
