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(Pediatrics in Review. 2007;28:389-394.)
© 2007 American Academy of Pediatrics

Index of Suspicion

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

	Case 1 Presentation

 
A 10-month-old Caucasian boy is referred to the GI clinic because of a 3-month history of recurrent vomiting, abdominal pain, and weight loss, for which he has been hospitalized twice. The vomiting has occurred two to three times per week, is nonprojectile and nonbilious, and has no relation to eating. The abdominal pain has been crampy, occurs primarily in the daytime, and does not correlate with eating or stooling. No specific location for the pain has been identified. The infant has lost 5 lb over the last 3 months.

His daily diet includes 6 to 8 oz of milk, 16 to 24 oz of juice, 16 to 24 oz of water, and table foods, including beef. His stools have been normal, he has slept well, and there is no family history of similar disorders.

Previous studies have included CBC, comprehensive metabolic panel, hantavirus immunoglobulin G and M (IgA/IgM) titers, urinalysis, stool cultures, and testing for Clostridium difficile toxin A and B and the antigens of rotavirus, Giardia, and Cryptosporidium. All results have been normal or negative.

On examination, the child is at the 5th percentile for weight, 4th percentile for height, and 16th percentile for head circumference. All other findings are normal. The following studies yield normal results: iron, amylase and lipase, C-reactive protein, ESR, thyroglobulin-stimulating hormone, free thyroxine, serum IgA, and upper GI radiographic series. Tissue transglutaminase and gliadin antibody IgG and IgA concentrations are normal. He has an Hgb value of 13 g/dL (130 g/L), Hct of 37% (0.37), platelet count of 305x10³/mcL (305x10⁹/L), and WBC count of 9.62x10³/mcL (9.62x10⁹/L) (36% neutrophils, 44% lymphocytes, 5% monocytes, 15% eosinophils). One additional study reveals the diagnosis.

	Case 2 Presentation

 
A 12-year-old girl who was treated at 18 months of age . . . [Full Text of this Article]

Russell Hopp, DO
Nagendra Natarajan, MD
Creighton University, Omaha, NE

Mary L. Lewis, MD
Karthik Krishnan, MD
Medical College of Georgia, Augusta, Ga

Warees T. Muhammad, MD, PhD
Children's Hospital at the Medical Center of Central Georgia, Macon, Ga.; James Logan, MD, Mercer University School of Medicine, Macon, Ga

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