Review of a Case With Vague Presenting Symptoms in Preparation for Clinical Rotations

Background: Conducting scholarly reviews of case studies as a preclinical medical student is a crucial supplement to classroom didactics and provides students with a clinical framework that can be applied throughout future clinical rotations. Case Information: In review of An 18.5-Month-Old Girl with Watery Diarrhea and Poor Weight Gain from New England Journal of Medicine (2010; 362:1619-1626), an otherwise healthy female infant presents with a reported 6 month history of watery diarrhea up to 15x per day. The child's weight decreased from 56th percentile at 7 months to < 10th percentile. Physical exam was normal without any organomegaly, tenderness, or masses. An extensive diagnostic workup was completed ruling out common food allergies, gluten-sensitive enteropathy, cystic fibrosis, and an invasive organism. Finally, the possibility of a tumor and associated paraneoplastic syndrome was considered, and a measurement of urinary catecholamines revealed elevated levels. A CT scan showed a calcified retroperitoneal mass without evidence of invasion. The mass was fully resected consistent with ganglioneuroma. At follow-up, the child was thriving without evidence of recurrent disease and normal catecholamine levels. Conclusions: Without prompt diagnosis, the outcome of this case could have been catastrophic leading to continued failure to thrive and developmental abnormalities. Using the case presented as a framework, I have developed my own systematic approach for patients presenting with vague symptoms. Furthermore, I keep tumors and cancerous etiologies at the forefront of my mind when developing differentials for patients with non-specific symptoms ensuring earlier diagnoses and interventions.