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(Pediatrics in Review. 2008;29:355-361.)
© 2008 American Academy of Pediatrics

Index of Suspicion

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


   Case 1 Presentation
 
A 15-year-old boy is admitted to the hospital because of a prolonged generalized seizure after having become progressively lethargic over the past 24 hours. He has a 1-week history of malaise, anorexia, and headaches. His Glasgow Coma Scale (GCS) score is 8/15. Despite termination of abnormal movements following administration of intravenous anticonvulsants, his level of consciousness remains depressed, and endotracheal intubation is performed. He is admitted to the intensive care unit. CT scan of his head shows no focal abnormalities.

He has a mild global developmental delay of unknown cause. He had three febrile convulsions at age 3 years and one generalized seizure when 9 years old. He takes no medication, is fully immunized, and has no family history of similar illness.

The boy fails to waken after sedative medications are stopped. On physical examination, he remains comatose and has a GCS score of 4/15. His temperature is 100.76°F (38.2°C), pulse is 98 beats/min, and blood pressure is 127/68 mm Hg. Abnormal muscle tone and intermittent extensor posturing are noted. Pupils are equal in size and reactive. No neck stiffness or rash is noted. All other physical findings are normal.

His hemoglobin concentration is 12.3 g/dL (123.0 g/L), WBC count is 8.0x103/mcL (8.0x109/L), and platelet count is 257.0x103/mcL (257.0x109/L). Serum electrolytes, C-reactive protein, BUN concentration, creatinine concentration, and coagulation studies are within normal limits. All cultures remain negative. An EEG shows diffuse, severe, nonspecific encephalopathy, but no epileptiform discharges. An additional test result reveals the underlying cause of his illness.


   Case 2 Presentation
 
A 14-year-old boy who has a past history of asthma, allergic rhinitis, sinusitis, and two previous hospitalizations for pneumonia presents to the ED with fewer than 24 hours of severe, worsening respiratory distress and temperature to 103.0°F (39.5°C). . . . [Full Text of this Article]


Nicole L. Mettauer, MD
Christine M. Pierce, MB
Mark J. Peters, MB, PhD
 Great Ormond Street Hospital, London, United Kingdom

Michelle Alletag, MD
Craig Huang, MD
 University of Texas Southwestern Medical Center at Dallas, Dallas, Tex

Stella U. Kalu, MD
 University of Texas Medical Branch, Galveston, Tex

Bradley J. Sullivan, MD, PhD
 Marshfield Clinic, Marshfield, Wisc

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