Make the Diagnosis: Spring 2021

“Jessica” is a bright 16-year-old high school freshman. On a snowy February day, she and her dad presented to our office for a copy of her immunization records. Our team noted that Jessica was overdue for a well visit and saw I had an open slot. The family willingly accepted the appointment, turning their 5-minute encounter with us for records into a 2-hour holistic visit.

While Jessica is an extremely motivated high school student who wants to go to college, she had many concerns to share: chronic abdominal pain, loneliness, despair during the pandemic, and significant family disruption. After completing her depression screen, Jessica shared that her positive symptoms centered on her tenuous relationship with her mother, who had “kicked her out of the house” 3 months ago. Through our comprehensive adolescent wellness questionnaire, Jessica disclosed she identifies as bisexual and has sex with both men and women. Because of her plans for the future, she also discussed wanting to start a contraceptive method and her fear of sexually transmitted infections. Her physical symptoms were vague headaches, abdominal pain, increased cramping with her menstrual cycle, and light vaginal discharge.

Congratulations to Sanatkumar S. Dagli, MD, of Yonkers, New York, who was the first to correctly guess the answer to last issue’s Make the Diagnosis challenge. The answer is multisystem inflammatory syndrome in children, the subject of this issue’s cover article.