Agraphia Medical Tragicomedy

15Sep/09Off

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Working the pediatric ED overnight, I got called to a room for an urgent transfer. An attending physician at another institution had decided this child was beyond his scope of care, and sent the kid by ambulance to us for further workup.

The story as I got it: Previously healthy 5 year old boy with a retropharyngeal abscess so big it was starting to swell out the back of the neck. Feverish, lethargic, sick looking kid. The other doctor had started him on very hefty IV antibiotics, drawn blood cultures, loaded him with fluids, and shipped him to us as quickly as possible. This child needed ICU monitoring and surgery for the abscess.

I walked in the room and was immediately struck by how wrong the other doc was. Even to my fairly untrained eye, I could tell this "abscess out the back of his neck" was just a lymph node.

Odd, because only two diseases commonly cause enlarged lymph nodes on the back of the neck. The first is HIV (much less likely in this particular 5 year old)... and the second is mononucleosis, colloquially known as the kissing disease, requiring only lots of TLC and chicken soup.

So, instead of sending him to the PICU with urgent surgical consult like the transferring doctor wanted, I ordered only one test - a confirmation for mononucleosis. 20 minutes later it came back positive.

I was walking on a cloud for the rest of the night.

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  1. in other words… zac is awesome

  2. Article on TIME related to what you’re doing. But I say, On With the Show
    http://www.time.com/time/health/article/0,8599,1925430,00.html


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