CASE 4
A 9-year-old girl presented with low-grade fever, sore throat, and malaise for 2 days. These symptoms developed 10 days after arriving at a summer camp operated by a religious group. Recently, she was noted to have a dry cough and difficulty breathing. Her parents then brought her to the emergency department.
PHYSICAL EXAMINATION
PE: The patient was in severe distress; respiratory stridor was present; exudative pharyngitis (Fig. 4-1) and bilateral cervical adenopathy (“bull neck”) were noted. A yellowish, leathery, thick membrane extending to the uvula and soft palate was also seen (see Fig. 4-1).
LABORATORY STUDIES
Diagnostic Work-Up
Table 4-1 lists the likely causes of illness (differential diagnosis). Investigational approach for delineating the etiology may include:
TABLE 4-1 Differential Diagnosis and Rationale for Inclusion (consideration)
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