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(Pediatrics in Review. 2007;28:305-311.)
© 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 4-month-old girl is brought to the ED because of fever and loss of appetite. Yesterday she was less playful than usual and whined instead of crying. She took only 3 oz of formula, after which she vomited twice. She refused other feedings and urinated only once during the day. Four days ago, she had rhinorrhea, but had no cough, diarrhea, or sick contacts. She was lethargic this morning and had a temperature of 99.5°F (37.5°C), prompting the visit.

On physical examination, the baby appears lethargic, but is afebrile and has stable vital signs. Her fontanelle is full, and she has bruises on the helix of her left ear and a left hemotympanum. In the ED, she has a tonic seizure with leftward gaze and absence of right-sided movement. Lorazepam is administered, she is intubated, and she receives a loading dose of fosphenytoin.

Laboratory findings include: WBC count of 26.08x103/mcL (26.08x109/L) with 80% neutrophils, 5% monocytes, and 14% lymphocytes; hemoglobin of 9.5 g/dL (95 g/L); hematocrit of 29.7% (0.297); and platelet count of 387x103/mcL (387x109/L). Prothrombin time is 15.3 seconds, and partial thromboplastin time is 26.1 seconds. Basic metabolic panel results are normal, as are findings on urinalysis. Rapid tests for respiratory syncytial virus and influenza as well as blood and urine cultures are negative. An additional procedure reveals the reason for her condition.


   Case 2 Presentation
 
A 14-year-old girl is seen for a 5-day history of vertigo, nausea, vomiting, headache, and ataxia. The onset of her illness was sudden and dramatic, with her symptoms awakening her from sleep. Paramedics felt that she had a flulike syndrome and did not take her to the hospital. Later that day, she experienced clumsiness in walking and right facial weakness. On day 2 of . . . [Full Text of this Article]


Allison Jackson, MD, MPH
Zarir Khademian, MD
Rachel Y. Moon, MD
Elizabeth Berger, MD
Adam Kirton, MD
Gabrielle deVeber, MD
Latha Chandran
Adelaide W. During
Dvorah Balsam
 Children's National Medical Center, Washington, DC
Hospital for Sick Children, Toronto, Ontario, Canada
State University of New York Medical Center at Stony Brook, Stony Brook, NY

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Pediatrics Pediatrics in Review
Copyright © 2007 by the American Academy of Pediatrics.