Pediatrics in Review
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(Pediatrics in Review. 2007;28:63-68.)
© 2007 American Academy of Pediatrics

Index of Suspicion

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


   Case 1 Presentation
 
An 8-month-old girl has had a fever for 10 days (maximum temperature, 104.3°F [40.2°C]) without signs of respiratory tract infection, emesis, rash, or joint abnormalities or illness contacts. Her intake of solids has diminished, but her liquid intake has been normal. Urine dipstick tests on catheterized specimens 9 days and 3 days ago were positive for white blood cells and leukocyte esterase, but both urine cultures produced negative results. She was treated with trimethoprim-sulfamethoxazole orally for 3 days after the first positive urine dipstick test and received daily ceftriaxone intramuscularly after the second. In the last 2 days, her urine has looked "milky."

Physical examination reveals a playful, interactive infant who has a temperature of 99°F (37.2°C). All findings are normal except for the presence of a coloboma of her right iris. Her WBC count is 17.8x 103/mcL (17.8x109/L) (42% neutrophils and 40% lymphocytes), platelet count is 1,128x 103/mcL (1,128x109/L), and ESR is 120 mm/h.

Renal ultrasonography, obtained because of the urinary findings, reveals a rounded, 4-cm, homogenous, relatively hypoechoic mass medial to and displacing the left kidney.


   Case 2 Presentation
 
An 11-year-old boy has had asthma and allergic rhinitis since the age of 4 years. His asthma has been well controlled until recently, when he has experienced hard-to-control episodes of respiratory distress. He presents to the ED for the fourth time in 10 days because of chest tightness and odd noises in his throat following exposure to dusty conditions. The episodes are characterized by the rapid onset of dyspnea, nonproductive cough, and suprasternal retractions. The episodes have continued despite a brief course of oral steroids, and the response to bronchodilators has been inconsistent. However, the episodes resolve without other therapy, usually within minutes.

In the ED, his vital signs are stable, and . . . [Full Text of this Article]


Nicole Paradise Black, MD
Risha Gatlin, MD
Ronald Emerick, MD
 Shands Children’s Hospital at the University of Florida, Gainesville, Fla

Patrick O. Sobande, MD
 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

Maja Marinkovic, MD
Jared Capouya, MD
David Cimino, MD
 University of South Florida, Tampa, Fla

Click here for Index of Suspicion Supplemental Data Data Supplement




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Copyright © 2007 by the American Academy of Pediatrics.