Index of Suspicion

    February 2013 in “ Pediatrics in Review ”
    Rafael Castillo, Juana Rodrı́guez, René Núñez, A. Torralbas
    TLDR The girl's symptoms suggest a complex condition that's hard to diagnose despite normal test results.
    A 17-year-old girl experienced intermittent swelling and pain in her right upper extremity over 2 years, beginning after an episode of Bell’s palsy. Her symptoms included swelling, "electrical shooting" pain, coolness, and decreased range of motion, with recent residual weakness. Examination showed swelling, decreased hair growth, and cooler temperature in the right arm, but normal peripheral pulses and capillary refill. Laboratory tests and imaging, including MRI and ultrasonography, were largely normal, ruling out several potential causes. The case highlighted a complex presentation with normal diagnostic results, suggesting a challenging diagnosis.
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