15. In Sight but out of Mind

  1. James C. Pile7,
  2. Thomas E. Baudendistel8 and
  3. Brian J. Harte9
  1. Letizia Attala1,
  2. Adam Tremblay2,
  3. Giampaolo Corti1,
  4. Sanjay Saint3,4,5,6 and
  5. Alessandro Bartoloni1,6

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch15

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Attala, L., Tremblay, A., Corti, G., Saint, S. and Bartoloni, A. (2013) In Sight but out of Mind, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch15

Editor Information

  1. 7

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 8

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 9

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    University of Florence Medical School, Florence, Italy

  2. 2

    Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor, Michigan, USA

  3. 3

    Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

  4. 4

    Ann Arbor VA Health Services Research and Development Field Program, Ann Arbor, Michigan, USA

  5. 5

    Patient Safety Enhancement Program, University of Michigan Health System, Ann Arbor, Michigan, USA

  6. 6

    Tuscan-American Safety Collaborative, Florence, Italy

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206



  • fever;
  • measles;
  • pneumonia;
  • rash;
  • toxic shock syndrome


The case study discussed in this chapter highlights two important aspects of making a difficult clinical diagnosis. First, the patient did not recall her immunization history, and the clinical team did not clarify it, and thus potential childhood illnesses such as measles and rubella did not remain on the differential diagnosis. Second, many diseases that commonly afflict children can also occur in adult patients, albeit less frequently. For both the discussant and the clinical team, the rash was clearly in sight but the correct diagnosis was out of mind given the rarity of this infection in adults. Fortunately, however, once it became clear that the patient was unlikely to have toxic shock syndrome, the epidemiological detail initially left behind became the sentinel clue necessary to solve the case. Measles tends to cause relatively severe illness and frequent complications in adults, the most common of which is pneumonia.