Pediatrics in Review
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INDEX OF SUSPICION

Whitney C. Edwards MD1
Rubia Khalak MD2
Robert Gadawski MD2
Franz E. Babl MD3
Jeffrey S. Hyams MD3
Christopher J. Justinich MD3
 1 Maine Medical Center, Portland, ME
2 University of Rochester School of Medicine and Dentistry, Rochester, NY
3 University of Connecticut School of Medicine, Hartford and Farmington, CT

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 boy is seen in the pediatric clinic. He has been ill for 3 weeks with fever, pharyngitis, and rash. Diagnosed as having streptococal pharyngitis and scarlet fever, he was treated with antibiotics without relief. Ten days ago, he developed vomiting, diarrhea, and right-sided abdominal pain. When given paregoric, his vomiting worsened. Six days ago he was admitted to a community hospital for treatment of dehydration. During his 3-day admission, his white blood cell count and his liver enzymes were elevated. At the time of discharge, he was no longer vomiting, but he had blisters on his hands and feet.

Two days ago, the vomiting, diarrhea, and abdominal pain recurred. Findings on abdominal ultrasonography were normal.






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Copyright © 1996 by the American Academy of Pediatrics.