Case 1: Progressive Weakness in a Previously Healthy 4-year-old Boy

Kristen Pontiff; Day Breen; Pamela McMahon; Cristina Zeretzke-Bien; Philip Zachariah; Christopher Woodward

doi:10.1542/pir.2016-0141

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Kristen Pontiff, MD*
Day Breen, MD^†
Pamela McMahon, PhD, MPH*
Cristina Zeretzke-Bien, MD^‡
Philip Zachariah, MD^§
Christopher Woodward, DO*,^§

^*Pediatric Residency Program, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
^†Neurodevelopmental Disabilities, Pediatric Neurology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
^‡Department of Emergency Medicine, University of Florida, Gainesville, FL
^§Emergency Medicine Residency Program–Baton Rouge, Louisiana State University Health Sciences Center, Baton Rouge, LA

AUTHOR DISCLOSURE
Drs Pontiff, Breen, Zeretzke-Bien, Zachariah, and Woodward have disclosed no financial relationships relevant to this article. Dr McMahon has disclosed that she serves as an evaluator on an Accreditation Council on Graduate Medical Education “Pursuing Excellence in Clinical Learning Environments” grant. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

EDITOR’S NOTE

Ahh, summertime! Some of us look forward to vacations, perhaps reading on a beach or in a quiet forest. We like summer as we share stories with friends, make new memories, and broaden horizons. Of course, you can take Pediatrics in Review along on your summer vacations! You can enjoy the “stories” of Index of Suspicion cases, and you can make new memories as you learn of new diagnoses and treatments. You can broaden the scope of your care of future patients. You might even see a patient later this summer who has one of the diagnoses featured in this month’s issue. Enjoy!

Philip R. Fischer, MD

Associate Editor, Index of Suspicion

Presentation

A previously healthy 4-year-old boy is carried into the emergency department with progressive weakness affecting all 4 extremities for a 24-hour duration. For the past 2 days, the boy has been more fatigued and complaining of right knee and lower back pain. The parents report no history of trauma. He has a normal appetite, without nausea, vomiting, or recent gastrointestinal illness. He has no dysuria, polyuria or incontinence, …