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(Pediatrics in Review. 2006;27:189-194.)
© 2006 American Academy of Pediatrics

Index of Suspicion

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

	Frequently Used Abbreviations

 

ALT:

alanine aminotransferase

AST:

aspartate aminotransferase

BUN:

blood urea nitrogen

CBC:

complete blood count

CNS:

central nervous system

CSF:

cerebrospinal fluid

CT:

computed tomography

ECG:

electrocardiography

ED:

emergency department

EEG:

electroencephalography

ESR:

erythrocyte sedimentation rate

GI:

gastrointestinal

GU:

genitourinary

Hct:

hematocrit

Hgb:

hemoglobin

MRI:

magnetic resonance imaging

WBC:

white blood cell

	Case 1 Presentation

 
A 4-year-old girl is evaluated for fever and joint pain. Six weeks ago, she was seen for acute left hip pain and refusal to walk. She had a normal CBC, antinuclear antibody titer, and radiographs of the hip and was diagnosed as having postviral arthralgia. Since then, her left hip pain has migrated to the left sacral area, elbow, and shoulder, and she has developed generalized body pain. The joint pain has no temporal pattern. She has had occasional drenching night sweats, low-grade fevers (99° to 100°F [37.3° to 37.8°C]), decreased appetite, and malaise, but no weight loss, nausea, or vomiting.

On examination, the child is well developed and alert. Her heart rate is 166 beats/min, respiratory rate is 24 breaths/min, blood pressure is 106/74 mm Hg, and height and weight are in the 25th to 50th percentiles. A 2-cm, mobile, smooth, nontender lymph node is palpable in the left posterior cervical triangle. No overlying erythema or supraclavicular lymphadenopathy is present. A grade 1/6 systolic murmur is audible; femoral pulses are normal. There is no splenomegaly, hepatomegaly, or abdominal mass. No joint warmth, effusion, or tenderness is present. Skin examination demonstrates pallor, but no jaundice, petechiae, or bruising.

Laboratory results are: WBC count, 7.45x10³/mcL (7.45x10⁹/L), with 44% neutrophils, 44% lymphocytes, and 10% monocytes; Hgb, 9.8 g/dL (98 g/L); platelet count, 424x10³/dL (424x10⁹/L); reticulocyte count, 1.2%; alkaline phosphatase, 1,473 U/L; and C-reactive protein, 4.8 ng/mL. Further imaging and . . . [Full Text of this Article]

Ara Festekjian, MD
Children’s Hospital of Los Angeles, Los Angeles, Calif

Stacy B. Pierson, MD
All Children’s Hospital, St. Petersburg, Fla

David Zlotkin, MD
Texas Tech Health Science Center, Lubbock, Tex

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