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Index of SuspicionCase 1: Fever, Diarrhea, Jaundice, and Confusion in an 18-Year-Old MaleCase 2: Severe Anemia in a 6-Month-Old GirlCase 3: Red Urine in a 4-Month-Old Boy

Elaine Ku, Nicholas S. Whipple, J. Bryan Carmody, Michelle Thomas, Cynthia H. Ho, Omar Abdul-Rahman, Gail C. Megason, Betty L. Herrington and Jennifer R. Charlton
Pediatrics in Review March 2014, 35 (3) 129-135; DOI: https://doi.org/10.1542/pir.35-3-129
Elaine Ku
University of California, San Francisco, CA;
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Nicholas S. Whipple
University of California, San Francisco, CA;
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J. Bryan Carmody
University of California, San Francisco, CA;
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Michelle Thomas
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Cynthia H. Ho
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Omar Abdul-Rahman
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Gail C. Megason
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Betty L. Herrington
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Jennifer R. Charlton
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The reader is encouraged to write possible diagnoses for each case before turning to the discussion. We invite readers to contribute case presentations and discussions. Please inquire first by contacting Dr. Deepak Kamat at DKamat@med.wayne.edu.

Case 1 Presentation

An 18-year-old male with a 3-year history of alcohol abuse is referred from a rehabilitation center for fever, nausea, and nonbloody diarrhea for 3 days. Six weeks ago, he enrolled in an alcohol rehabilitation program and stopped drinking alcohol. Three weeks later, he noticed yellowing of his eyes and skin, difficulty sleeping, and dyspnea.

On examination, his temperature is 100.6°F (38.1°C), blood pressure is 99/62 mm Hg, pulse is 124 beats per minute, and respiratory rate is 24 breaths per minute. He is slow to answer questions. There is no asterixis. He appears thin and jaundiced with enlarged parotid glands. Decreased breath sounds are noted on the right. A tender, enlarged liver and mild abdominal distension are noted. Trace bilateral lower-extremity edema is present. No stigmata of chronic liver disease are found.

Laboratory findings reveal the following: white blood cell count, 25,600/μL (25.6 × 109/L) (87% neutrophils); hemoglobin, 8.2 g/dL (82 g/L); mean corpuscular volume, 106 fL; platelets, 40 × 103/μL (40 × 109/L); sodium, 135 mEq/L (135 mmol/L); potassium, 3.5 mEq/L (3.5 mmol/L); chloride, 106 mEq/L (106 mmol/L); bicarbonate, 15 mEq/L (15 mmol/L); blood urea nitrogen, 24 mg/dL (8.6 mmol/L); creatinine, 1.01 mg/dL (89 μmol/L); glucose, 118 mg/dL (6.6 mmol/L); alkaline phosphatase, 182 U/L; aspartate aminotransferase (AST), 194 U/L; alanine aminotransferase (ALT), 71 U/L; total bilirubin, 11.8 mg/dL (201.8 μmol/L); direct bilirubin, 7.3 mg/dL (124.9 μmol/L); albumin, 2.7 g/dL (27 g/L); prothrombin time, 19.2 seconds; and international normalized ratio, 1.4. Ethanol and acetaminophen were not detected in the serum.

A chest radiograph reveals a right pleural effusion …

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Pediatrics in Review: 35 (3)
Pediatrics in Review
Vol. 35, Issue 3
1 Mar 2014
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Index of SuspicionCase 1: Fever, Diarrhea, Jaundice, and Confusion in an 18-Year-Old MaleCase 2: Severe Anemia in a 6-Month-Old GirlCase 3: Red Urine in a 4-Month-Old Boy
Elaine Ku, Nicholas S. Whipple, J. Bryan Carmody, Michelle Thomas, Cynthia H. Ho, Omar Abdul-Rahman, Gail C. Megason, Betty L. Herrington, Jennifer R. Charlton
Pediatrics in Review Mar 2014, 35 (3) 129-135; DOI: 10.1542/pir.35-3-129

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Index of SuspicionCase 1: Fever, Diarrhea, Jaundice, and Confusion in an 18-Year-Old MaleCase 2: Severe Anemia in a 6-Month-Old GirlCase 3: Red Urine in a 4-Month-Old Boy
Elaine Ku, Nicholas S. Whipple, J. Bryan Carmody, Michelle Thomas, Cynthia H. Ho, Omar Abdul-Rahman, Gail C. Megason, Betty L. Herrington, Jennifer R. Charlton
Pediatrics in Review Mar 2014, 35 (3) 129-135; DOI: 10.1542/pir.35-3-129
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