INDEX OF SUSPICION
John L. Green MD
David M. Tejeda MD1
1 California Pacific Medical Center, San Francisco, CA
Editors: Lawrence F. Nazarian, MD.
This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
You are seeing an 8-year-old boy with the complaint of left knee pain and limp during the previous week. His mother reports that at times he plays well and seems fine, and at other times he limps noticeably on his left side and walks stiff-begged with his left knee aching. He has had a low temperature of 100°F to 101°F (37.7°C to 38.3°C) intermittently over the last few days, but generally has slept and eaten well.
On examination, he is cooperative, pleasant, and comfortable at rest, but looks noticeably pale. He does walk rather stiff-legged on the left side, with a mild limp both on walking and running. His knees are symmetrical al and equal in circumference, with full range of motion.
