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1. Raymond Cai, MD* 2. Vikram Bhise, MD† 1. *Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 2. †Department Neurology and Pediatrics, Robert Wood Johnson University Hospital, New Brunswick, NJ I spent a week with medical students and family medicine residents in northeast Africa earlier this year. There, bright, clinically astute trainees at a major university use Pediatrics in Review as a core foundation of their pediatric curriculum. Wherever you are in the world this month, may these Index of Suspicion cases help you advance your knowledge and practice of pediatrics. Philip R. Fischer, MD Associate Editor, Index of Suspicion A 13-year-old girl presented to the emergency department with acute onset of lower extremity weakness. She first awoke with dizziness but soon developed severe back pain, bilateral lower extremity pain and numbness, slurred speech, and inability to move her lower extremities or ambulate. She reports having a 2-day history of headaches and back pain. Due to worsening of her symptoms, she went to an urgent care center the previous day. A rapid viral test showed she was influenza positive, and she took 2 doses of oseltamivir before admission. The patient had an upper respiratory tract infection approximately 2 to 3 weeks ago. In the emergency department, the patient is unable to void spontaneously despite being able to at home, and a urinary catheter is placed. On physical examination her vital signs are as follows: temperature, 98.6°F (37.0°C); heart rate, 77 beats/min; respiratory rate, 20 breaths/min; and blood pressure, 119/74 mm Hg. Her BMI was within the 75th to 85th percentile. Her lower extremities bilaterally had 1/5 strength, diminished sensation to pinprick and temperature, and 0/5 patellar reflexes. She also had a 0/5 right Achilles reflex but a 1/5 …