INDEX OF SUSPICION
Arthur S. Dover MD1
Barry A. Love MD2
Nasha't M. Khanfar MD3
1 Freedom, CA
2 Montreal Children's Hospital, Montreal, Canada
3 Mayo Clinic, Rochester, MN
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
A 7-year-old girl is admitted to the hospital because of 9 days of gastrointestinal illness with fever. Her illness began with watery green diarrhea that has persisted. She has had several stools each day: no pus, blood, or mucus has appeared in the stool. She has been vomiting up to six times a day, with bile noted in the vomitus at times. Abdominal pain has been present almost constantly from the onset. The pain has been generalized except for intermittent periods of right-sided lower abdominal, groin, and leg discomfort. Fever in a daily spiking pattern and chills have occurred since shortly after her illness began. She has complained of a frontal headache and has had a mild cough.
