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(Pediatrics in Review. 2006;27:463-469.)
© 2006 American Academy of Pediatrics

Index of Suspicion

The first 300 words of the full text of this article appear below.


   Case 1 Presentation
 
A 4-month-old twin boy is admitted to the hospital for respiratory distress. He has had an intermittent cough for 2 months. His oral intake also has declined, and he has gained no weight in the past 3 weeks. During an admission 10 days ago, a chest radiograph showed perihilar interstitial infiltrates, but results of viral immunofluorescence testing, pertussis culture, pH probe, and a sweat chloride test all were negative. He was discharged on nasogastric feedings with a working diagnosis of oral aversion. At a gastroenterology clinic visit today, he appeared dusky, had an oxygen saturation of 70%, and was rushed to the ED. Coincidentally, during evaluation for a cough of 1 month’s duration, his twin brother also was found to be hypoxic and was admitted to the hospital. The other siblings are healthy, and both twins have received two sets of vaccines.

On examination, the patient weighs 4.5 kg (<5th percentile), is 66 cm long (75th percentile), and has a temperature of 100.6°F (38.1°C) and a respiratory rate of 60 breaths/min. His oxygen saturation is in the 90s while receiving 1 L oxygen. He has crackles and expiratory wheezing bilaterally, with intercostal retractions. No lymph nodes are palpable, and cardiac and abdominal findings are normal.

His WBC count is 13x103/mcL (13x109/L), with 80% neutrophils and 14% lymphocytes. A chest radiograph demonstrates diffuse bilateral interstitial infiltrates. Bronchoalveolar lavage leads to the diagnosis.


   Case 2 Presentation
 
A 16-year-old boy is brought to the ED with a 9-day history of fever, malaise, and myalgias. Yesterday he developed a strong urge but inability to urinate as well as weakness that made it difficult for him to rise from a chair and to walk. He denies back pain but had a single episode of bowel incontinence yesterday.

On physical examination, the boy’s . . . [Full Text of this Article]


Zackary Taylor, MD
Lavjay Butani, MD
Dean Blumberg, MD
 University of California Medical Center at Davis, Davis, Calif

Mort Cowan, MD
Diane Wara, MD
 University of California Medical Center at San Francisco, San Francisco, Calif

Satish Gopal, MD, MPH
 Norwalk Hospital, Norwalk, Conn

Cristina Gavrilita, MD
Shonola Da-Silva, MD
 The Children’s Regional Hospital, Cooper University Hospital, Camden, NJ

Click here for Index of Suspicion Supplemental Data Data Supplement




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Copyright © 2006 by the American Academy of Pediatrics.