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(Pediatrics in Review. 2007;28:111-117.)
© 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 18-year-old boy comes to the ED with a 3-day history of a rash. Initially noted on both hands, the discrete, flat, circumscribed red lesions now are present on his arms and feet and are mildly itchy. He reports feeling tired and had experienced headache and subjective fever 2 days ago. His right knee is mildly swollen, causing him to limp. He has not noted any redness around the joint but complains of vague pain. He denies dysuria, back pain, abdominal pain, sore throat, or genital sores. He is sexually active but denies any history of sexually transmitted diseases, illicit drug use, or urinary tract infection.

Physical examination reveals a healthy-looking adolescent who has normal vital signs. Positive findings include injected conjunctivae with no exudates or photophobia. His right knee has a mild effusion but no tenderness or redness. A faint macular, petechial rash is noted on both his palms and lower extremities, including his soles. No pharyngeal exudates, generalized lymphadenopathy, or hepatomegaly are apparent. The rest of his physical findings are normal.

Laboratory results include a normal WBC count and electrolyte values. Urinalysis shows no leukocytes. His ESR is 42 mm/h. A 1-mL serosanguineous aspirate from the right knee is sent for culture; Gram stain shows no leukocytes or organisms. Blood culture, rapid plasma reagin test, and hepatitis panel results are pending. The patient is admitted for additional evaluation.

When his father leaves the room, the patient reveals a piece of information that leads to the diagnosis.

	Case 2 Presentation

 
A 12-year-old girl from western Iran is hospitalized because of intermittent abdominal pain that started 9 months ago and has recurred every 3 to 4 weeks, the latest episode being 4 days ago. Each episode has followed excessive exercise and coincided with the middle of her menstrual cycle. The pain has been . . . [Full Text of this Article]

Raemma Paredes Luck, MD
Mitra Ahmad Soltani, MD
Juan F. Villalona, MD
Rebecca K. Lehman, MD
Marilyn R. Brown, ND
Koorosh Kooros, MD
Jennifer M. Kwon, MD
Temple University Children's Medical Center, Philadelphia, Pa.
Azad University Medical School, Tehran, Iran
Golisano Children's Hospital at Stong University of Rochester Medical Center, Rochester, NY

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