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(Pediatrics in Review. 2007;28:193-198.)
© 2007 American Academy of Pediatrics

Index of Suspicion

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


   Case 1 Presentation
 
A 14-year-old boy is seen because of fatigue. Although he has continued to be active in lacrosse, he complains of tiring easily. His mother thinks that his skin has been pale for a month. His stool is guaiac-positive, prompting referral to a gastroenterologist. He has never noticed any blood in his bowel movements. There is no history of abdominal or joint pain, diarrhea, fever, night sweats, mouth sores, or skin rashes. Although he has a good appetite, he has grown poorly.

Physical examination reveals a smiling, pleasant, pale adolescent. His heart rate is 100 beats/min and blood pressure is 118/67 mm Hg. Both height and weight are significantly below the 5th percentile. There are no perianal skin tags or fissures, and findings on rectal examination are normal, as are all other physical findings. The stool is brown without obvious blood and is guaiac-positive.

Laboratory results are: WBC count, 8.1x103/mcL (8.1x109/L); Hgb, 8.5 g/dL (85 g/L); platelet count, 285x103/dL (285x109/L); mean cell volume, 75 fL; reticulocyte count, 1.9% (0.019); ESR, 57 mm/h; prothrombin time, 13.9 seconds (normal, 11.1 to 13.7 sec); partial thromboplastin time, 27.2 seconds (normal, 22.8 to 34.7 sec); and albumin, 3.8 g/dL (38 g/L) (normal, 3.2 to 4.8 g/dL [32 to 48 g/L]). Serum electrolyte, ALT, AST, alkaline phosphatase, and bilirubin values are normal. His bone age is between 9 and 10 years, at least 4 years less than his chronologic age. A procedure and an additional element of history lead to the diagnosis.


   Case 2 Presentation
 
A 15-year-old Chinese boy presents with multiple hypopigmented patches widely distributed over his entire body. The lesions have been present since birth, and although their size has increased proportional to the increase in body size, the morphology has not changed over time. . . . [Full Text of this Article]


Cary M. Qualia, MD
Marilyn R. Brown, MD
Alexander K. C. Leung, MBBS
William Lane M. Robson, MD
Donald Janner, MD
Alexander Zouros, MD
Chalmer McClure, MD
Nathaniel Wycliffe, MD
Scott Barron, MD
 University of Rochester School of Medicine & Dentistry, Rochester, NY
University of Calgary, Calgary, Alberta, Canada
Loma Linda University Children's Hospital, Loma Linda, Calif.
Broadlawns Medical Center, Des Moines, Ia

Click here for Index of Suspicion Supplemental Data Data Supplement
Click here for Index of Suspicion Supplemental Data Data Supplement




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