Pediatrics in Review
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(Pediatrics in Review. 2007;28:343-351.)
© 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 3-month-old Latino boy has had 1 day of fever (102.3°F [39.1°C]) that is unresponsive to acetaminophen, a nonproductive cough, nasal discharge, and decreased oral intake. He has been fussy. Recently discharged from the hospital with a diagnosis of Escherichia coli pyelonephritis, he completed a 10-day course of amoxicillin 1 day ago. Renal ultrasonography and voiding cystourethrography had yielded normal findings. There has been no vomiting, diarrhea, rash, respiratory distress, or ill contacts.

On physical examination, the baby is alert, responsive, and in no acute distress. He has a respiratory rate of 40 breaths/min, and all other vital signs are normal. A mild amount of mucopurulent nasal discharge is noted, but his oropharynx is clear. On auscultation, he demonstrates coarse upper airway sounds. All other physical findings are normal.

Laboratory values include an Hgb concentration of 10.7 g/dL (107 g/L), WBC count of 7.5x103/mcL (7.5x109/L), and platelet count of 298x103/mcL (298x109/L). A chest radiograph reveals no infiltrates. Both urine and blood cultures obtained at an outside institution are reported as being positive for Enterococcus faecalis. An additional laboratory value and careful scrutiny reveal the diagnosis.


   Case 2 Presentation
 
A 9-year-old girl presents with pain and limited neck motion that began 10 weeks ago. She was seen by her pediatrician just before the neck complaints began for fever and sore throat and completed a course of penicillin for streptococcal pharyngitis. Her pain and fever resolved, but over the next few weeks, she began to hold her head with her chin rotated to the left. She was seen again and prescribed ibuprofen and heat. When her condition had not resolved in 1 month, she began physical therapy. At present, her range of motion has improved somewhat but has not been restored. She . . . [Full Text of this Article]


Alicia Rapson, MS, IV
 Jefferson Medical College, Philadelphia, Pa

David I. Rappaport, MD
 A.I. DuPont Hospital for Children, Wilmington, Del

Lainie Holman, MD
Linda Michaud, MD, PT
Emanuel Doyne, MD
Atiq Durrani, MD
 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Khristine Lanuza, MD
Jocelyn Ang, MD
Deepak Kamat, MD, PhD
 Children's Hospital of Michigan, Wayne State University, Detroit, Mich

Eric S. Silver, MD
 Morgan Stanley Children's Hospital of New York –Presbyterian, New York, NY

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Copyright © 2007 by the American Academy of Pediatrics.