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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

A 7-month-old boy is brought to your office because of swelling in his neck. He has a history of recurrent ear infections and had tympanostomy tubes inserted 2 weeks ago. Some ear drainage has been noted in the last few days. The child has had a recurrent rash on his face and scalp as well as a stubborn diaper rash that has not responded to nystatin ointment. He has had no fever and has been active and feeding well.

On examination, the child appears healthy, and his temperature is 36.5°C (97.8°F) rectally. There is a seborrhealike maculopapular rash on his forehead and scalp, with some interspersed petechiae; inflamed skin is noted in the perineal area.

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