As a first year infectious diseases fellow, I am frequently challenged to give a child an infectious disease diagnosis prior to proposing starting antibiotics. It brings me back to medical school, when we were taught to name the diseases, then the bugs that can cause that disease, then the drugs that can treat those bugs. I went into ID because of how neatly that thought process can be carried out, even in the most complicated patients.
However, every once in a while, that thought process breaks down, and our patients suffer. I consulted on a child this year with toxic epidermal necrolysis (TEN), which is a severe, often fatal, adverse cutaneous drug reaction that predominantly involves the skin and mucous membranes. She had had a few illnesses in a 3-month period which prompted a flurry of doctors’ visits, including multiple visits to the pediatrician, one visit to seek out a second opinion and one visit to an infectious diseases consultant.