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(Pediatrics in Review. 2006;27:351-357.)
© 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 16-year-old Caucasian girl comes in for a health supervision visit. She has been in good health, although she is concerned that she has not achieved menarche. Both her mother and sister attained menarche at age 13 years. She denies any unusual dieting patterns and has not been sexually active.

On physical examination, she is a pleasant girl whose height is far above the 97th percentile, weight is at the 10th percentile, and body mass index is 14.8. Her thyroid gland is not palpable. Her breasts are at Sexual Maturity Rating 3. She has normal abdominal findings when examined supine, but when standing and coughing, a 3.5-cm mass is palpable in her left inguinal canal. Her external genitalia have a normal female appearance, without clitoromegaly. She has minimal coarse pubic hair and no facial or axillary hair. The remainder of her physical findings are normal. Further testing reveals the reason for her delayed menarche.


   Case 2 Presentation
 
A 16-year-old boy has a 2-month history of progressive, reddish-purple, nonpainful, nonpruritic swelling around both eyes. There have been no other systemic features, including other rashes, joint pain, or muscle weakness. Orbital CT shows only periorbital soft-tissue swelling. Skin testing shows 3+ reactions to dust mite, dog, guinea pig, trees, grass, and weeds. He has not responded to oral steroids, intralesional steroid injections, or multiple antibiotics. Other than his ocular findings, the only positive physical findings include left sternocleidomastoid atrophy and minimal neck weakness.

He has a WBC count of 3.86x103/mcL (3.86x109/L) with lymphopenia and thrombocytopenia (125x103/mcL [125x109/L]). Bone marrow biopsy shows mild hypocellularity without signs of malignancy. The ESR and C-reactive protein, serum immunoglobulin, and complement levels are normal. Enzyme levels include AST of 47 U/L (normal, <40 U/L), lactate dehydrogenase (LDH) of . . . [Full Text of this Article]


Pranita Tamma, MD
Claude Migeon, MD
 Johns Hopkins School of Medicine, Baltimore, Md

Debabrata Ghosh, MD
Tobias Loddenkemper, MD
Bridget Wright, MD
Shannon Phillips, MD
Michael G. Levien, MD
Richard A. Prayson, MD
Philip Hashkes, MD
 The Cleveland Clinic Foundation, Cleveland, Ohio

Rebecca Dixon, MD
 Indiana University Purdue University, Riley Children’s at Methodist Hospital, Indianapolis, Ind

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