INDEX OF SUSPICION
Elizabeth R. Marino MD1
Robert B. Baker MD2
Jeffrey M. Devries MD, MPH3
Sanjiv B. Amin MD3
1 New Jersey Medical School, Newark, NJ
2 Southern California Permanente Medical Group, Bonita, CA
3 Henry Ford Hospital, Detroit, MI
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 and discussions.
Case 1 Presentation
You are seeing a 16-year-old male who has had nasal congestion that began a few months ago. The congestion was intermittent at first but has become constant. He denies sneezing, itchy eyes, or other respiratory difficulty. His mother is concerned because he often is awakened by his congestion. He frequently is irritable in the mornings, and she believes the sleep disturbance is responsible for the decline in his grades, which had been very good. Except for one uncle, no family members have complained of allergies.
He is a slim boy whose pulse is 90 beats/min, blood pressure is 136/80 mm Hg, and temperature is 98.8°F (37.1°C). Physical examination otherwise is normal except for mildly reddened, edematous nasal mucous membranes that have a small amount of thin white mucoid discharge.
