id	author	title	date	pages	extension	mime	words	sentences	flesch	summary	cache	txt
cord-002095-47dbqu2r	Al-Helou, Georges	When the Illness Goes Off Script—An Exercise in Clinical Reasoning	2016-03-14		.txt	text/plain	2844	184	44	The clinician triggers the illness scripts of familiar diseases such as viral or bacterial respiratory infections and tick-borne infections to compare to his problem representation. While disseminated endemic fungal infections can cause fever, rash, lymphadenopathy, and pulmonary disease, an acute presentation with widespread skin lesions would be more likely in an immunocompromised patient. The problem representation is now fever, hypotension (resolved), diffuse pulmonary infiltrates, widespread lymphadenopathy, disseminated rash (resolved), leukopenia, thrombocytopenia, DIC, severe AKI, and mild hepatitis with no evident infection. It is the mismatch between common illness scripts (pleural) 5 and a patient's presentation that prompts diagnosticians to consider rare diseases. Rare diseases such as HLH were considered only after the discussant found irreconcilable mismatches with the illness scripts of more common conditions. When clinicians know the illness scripts of common diseases well enough to recognize telltale deviations from the norm, they can trigger the consideration of rare conditions and request help from colleagues and other resources that will ultimately lead to a diagnosis.	./cache/cord-002095-47dbqu2r.txt	./txt/cord-002095-47dbqu2r.txt