
A 5 year old presents with fever, headache, and neck stiffness. What is on your differential diagnosis? I know that most of you, as you’re reading this chief complaint, are already thinking, “Let’s get the lumbar puncture kit ready!” But wait – are there any findings on history or physical examination that might make you re-think that plan? What if the patient also has bilateral leg pain? What if the patient has also had new onset nocturnal enuresis? What do you add or subtract to your differential diagnosis?
This month’s Diagnostic Dilemma and Clinical Reasoning (10.1542/peds.2015-3762) case reminds us that sometimes, not all is as it seems. We have all been trained since medical school to begin creating a differential diagnosis with every piece of information, starting with the chief complaint. However, it is probably good for most of us to be reminded occasionally that it is important to keep an open mind and consider all of the diagnostic possibilities whenever we go into a patient’s room.