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(Pediatrics in Review. 1997;18:379-382.)
© 1997 American Academy of Pediatrics

Index of Suspicion

This section ofPediatrics 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 diagnosis 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

 
A 2-year-old boy is brought to the emergency department at 4 AM because of a fever and a 6-hour history of intermittent fits of terror and screaming, with complaints of seeing rats. He has had clear rhinorrhea for 3 days. The boy is cared for by his father, who had put him to bed that night, at which time he was acting normally. The child awoke at 11 PM, screaming in terror and pointing to the floor. The father saw nothing where the boy was pointing and found it difficult to console the child.

The boy lives with his father and is visited by his mother daily, having spent the previous afternoon with her. The only medication in the father's house is an oral hypoglycemic agent; the mother is not on any medications. The father is unaware of exposure to any medications or other substances.

On physical examination, the boy's oral temperature is 40°C (104 °F), pulse is 190 beats/min, respiratory rate is 28 breaths/min, and blood pressure is 120/80 mm Hg. The child has a fluctuating mental status, at times appearing alert, calm, and playful, then displaying fits of terror, screaming and pointing at the floor. His pupils are 6 mm in diameter and constrict to 3 mm with light. There is a copious . . . [Full Text of this Article]