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(Pediatrics in Review. 2008;29:281-287.)
© 2008 American Academy of Pediatrics

Index of Suspicion

Key Words: ALT: alanine aminotransferase • AST: aspartate aminotransferase • BUN: blood urea nitrogen • CBC: complete blood count • CNS: central nervous system • CSF: cerebrospinal fluid • CT: computed tomography • ECG: electrocardiography • ED: emergency department • EEG: electroencephalography • ESR: erythrocyte sedimentation rate • GI: gastrointestinal • GU: genitourinary • Hct: hematocrit • Hgb: hemoglobin • MRI: magnetic resonance imaging • WBC: white blood cell

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

	Case 1 Presentation

 
A 7-year-old boy is seen in the ED for a febrile illness. Four days ago, he experienced 24 hours of fever (up to 104°F [40°C]), rigors, right upper quadrant abdominal pain, frontal headache, and decreased oral intake. He was diagnosed as having a viral illness. He improved slightly, but the fevers have returned after 4 days. The boy's family had emigrated from a refugee camp in Malawi 1 week before the onset of illness. He had been well previously, his only illness contact being his father, who had been afflicted with malaria 9 months earlier. The boy's immunization status is unknown.

On physical examination, the child looks ill but not toxic. His temperature is 103.8°F (39.9°C), heart rate is 125 beats/min, respiratory rate is 24 breaths/min, and blood pressure is 109/58 mm Hg. Both liver and spleen edges are palpable 3 cm below the costal margin, and mild right upper quadrant abdominal tenderness is present. No jaundice or rashes are noted, and his other physical findings are normal.

Laboratory tests show normal concentrations of electrolytes and measures of renal and liver function. His WBC count is 3.5x10³/mcL (3.5x10⁹/L) (neutrophils 40%, bands 16%, lymphocytes 37%, monocytes 7%), Hgb concentration is 10.9 g/dL (109.0 g/L), and platelet count is 260.0x10³mcL (260.0x10⁹/L). Thick and thin blood smears are negative for malaria. An additional diagnostic test reveals the cause of his illness.

	Case 2 Presentation

 
An 18-year-old African American girl has had pain, redness, and photophobia in her left eye for 1 week. For the last 3 days, she also has experienced blurred vision and floaters in her left eye. Today she has noted worsening vision in that eye. She has no concerns about her right eye. She denies any trauma to the left eye, . . . [Full Text of this Article]

Sergio Fanella, MD
Joanne Embree, MD
Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada

Bhawana Arora, MD
Sauraby Goel, MD
Children's Hospital of Michigan, Detroit, Mich

Frank J. Probst, MD, PhD
Ankita Patel, PhD
Arthur L. Beaudet, MD
Baylor College of Medicine, Houston, Tex

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