Case 1: New-Onset Seizures in a 16-year-old Girl Recently Emigrated from Africa

Abstract

1. Rachel Cafferty, MD†\n2. Cynthia Howard, MD, MPHTM†\n3. Rahul Kaila, MD‡\n\n\n \n\n1. †Department of Pediatrics, and\n\n2. ‡Department of Pediatric Emergency Medicine, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN\n\nAfter Match Day this month, some senior medical students will be heading off for global health rotations. Some residents and practicing physicians are finalizing plans for summer service-learning trips in countries far from home. Meanwhile, pediatric offices in North America are increasingly seeing recent immigrants who might carry conditions that seem uncommon. To help prepare all readers in all parts of the world, Index of Suspicion highlights cases this month that are particularly relevant to readers interested in global health.\n\nPhilip R. Fischer, MD\n\nAssociate Editor, Index of Suspicion \n\nA 16-year-old previously healthy girl with recent international emigration with refugee status from Tanzania presents via emergency medical services (EMS) with new-onset seizurelike activity. She had spent the 48 hours immediately before presentation traveling from Tanzania to the United States via Switzerland, with minimal sleep. The EMS was called to the home after the family found the girl lying on the floor covered in vomit with shaking movements of her extremities and eyes rolled back. She is without seizure activity and is not postictal in appearance when EMS arrives. She is noted to have a history of malaria several years earlier (treated and without recurrence), but no other medical problems. She has no personal or family history of seizure disorders, she is not taking medications, and there is no concern for illicit substance abuse, medication ingestion, or precipitating trauma. She has had no recent fever, headache, abdominal pain, vomiting, diarrhea, or other concerns.\n\nDuring transport to the emergency department (ED) she receives a dose of ondansetron. On arrival, her temperature is 98.4°F (36.9°C), respirations are 16 breaths/min, heart rate is …