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(Pediatrics in Review. 2008;29:131-136.)
© 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 12-year-old girl comes to the office in December complaining of 2 days of left knee swelling and pain. There is no history of trauma, overuse, rash, or fever, but she had mild nasal congestion and cough 1 week ago. She also has been complaining of intermittent back and shoulder pain for 2 months and has been examined without any significant findings appreciated.

On physical examination, her left knee is markedly swollen, but no erythema is evident. There is no pain on palpation of the knee joint, but she is unable to extend or flex the knee fully because of the pain and swelling. She has a negative drawer sign, and no laxity of the knee joint is noted. Transient synovitis is diagnosed presumptively, awaiting the results of blood tests. An orthopedist performs a puncture of the joint, but no fluid is aspirated. Laboratory tests that include a CBC, ESR, rheumatoid factor, antistreptolysin antibody, C-reactive protein, antinuclear antibody, and parvovirus titers yield normal results; the results of another test, however, lead to the diagnosis.

	Case 2 Presentation

 
A 14-year-old boy presents with a 4-week history of aching in his thighs and calves along with bilateral knee pain, desquamating palmar rash, weight loss, and hypertension, accompanied by anxiety, irritability, and a change in his mental status. In addition, he is experiencing episodic fevers, night sweats, and fatigue. His mother also has been exhibiting strange behavior, but no one else has the specific symptoms he has had. An 8th grade student, he has been failing classes and has had diminished concentration since the aching in his legs began. He denies using tobacco, alcohol, and illicit drugs and does not recall sick contacts or recent travel. He has had protected intercourse once. His father lays drywall, and his mother works in a plastics factory. His immunizations . . . [Full Text of this Article]

Jacob J. Rosenberg, MD
Nassau University Medical Center, East Meadow, NY

Vivek Prasad, MD
John Gaebler, MD
Riley Hospital for Children, Indianapolis, Ind

Naomi Dreisinger, MD
Shai Manzuri, MD
Beth Israel Medical Center, New York, NY

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