INDEX OF SUSPICION
Gregory P. Conners MD1
Angela E. Lin MD2
Juan A. Rivera MD3
1 University of Rochester School of Medicine & Dentistry, Rochester, NY
2 Westwood, MA
3 Vancouver, WA
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
An 18-year-old girl comes to your office complaining of a sore nose. She reports that the tip of her nose has been red and tender for the past few days and seems to be worsening. Because of the erythema, she was not allowed to do her usual volunteer work at a local nursing home. Her health has been good and she denies having any recent upper respiratory infections. She has not had fever and is taking no medication. She recalls having a similar nasal condition at least once before; it was not as uncomfortable and cleared up without treatment.
On physical examination, she is afebrile, and all other vital signs are normal. The tip of her nose is slightly but noticeably swollen, and the medial margin of her right nostril is moderately erythematous.
