Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20% to 30%) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.

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RESUMODor abdominal aguda é uma das principais queixas pediátricas com vários diagnósticos diferenciais. Paciente de dois anos e oito meses, do sexo feminino, negra, natural de Itapeva, São Paulo. Referia dor abdominal, diarreia e tosse havia 16 dias. Foi internada com hipótese diagnóstica de pneumonia. Durante a internação apresentou tosse, gemência, desconforto respiratório, vômitos, diarreia, distensão abdominal e febre. A má evolução do quadro e a piora da dor abdominal levaram à realização de uma tomografia abdominal que revelou apendicolitos. Foi encaminhada ao serviço de referência, onde houve a suspeita de apendicite aguda e foi realizada intervenção cirúrgica. O diagnóstico conclusivo foi de apendicite aguda purulenta. A paciente evoluiu dentro do esperado e teve alta dez dias após a cirurgia. Numerosos distúrbios podem causar dor abdominal; as causas mais comuns são gastroenterite e apendicite; porém, outros diagnósticos diferenciais devem ser considerados, entre eles pneumonia. No caso relatado, apesar de a paciente estar inicialmente taquidispneica, apresentava dor abdominal intensa e desidratação. Uma boa anamnese é fundamental. As alterações laboratoriais são inespecíficas e ocorrerem nos dois casos. Diante de um quadro de pneumonia com má evolução, é importante pensar na possibilidade de outro diagnóstico, entre eles apendicite, se o quadro vier acompanhado de dor abdominal, devido à sua alta morbimortalidade. Palavras-chave: dor abdominal; apendicite; pneumonia; doença aguda; diagnóstico diferencial; criança. ABSTRACTAcute abdominal pain is a major pediatric complain with a wide range of differential diagnoses. Pacient was two years and eight months, female, black, born in Itapeva, São Paulo, Brazil. She referred abdominal pain, diarrhea and cough for 16 days. She was hospitalized with a diagnosis of pneumonia. During hospitalization, she presented coughing, grunting, respiratory distress, vomiting, diarrhea, abdominal distension and fever. The bad evolution and worsening abdominal pain led to an abdominal tomography, which revealed appendix fecal calcifications. She was taken to the reference service, where there was suspicion of acute appendicitis and then surgery was performed. The final diagnosis was acute purulent appendicitis. The patient progressed as expected and was discharged ten days after surgery. Numerous disorders can cause abdominal pain; the most common causes are gastroenteritis and appendicitis. However, other differential diagnosis should be considered, including pneumonia. In the case reported, although the patient was initially tachydyspneic, she had severe abdominal pain and dehydration. A good medical history is essential. Laboratory abnormalities are nonspecific and occur in both cases. In cases in which pneumonia progresses with poor outcome, it is important to think about the possibility of another diagnosis, including appendicitis, if the complains include abdominal pain, due to its high morbidity and mortality. Keywords: abdominal pain; appendicitis; pneumonia; acute d...

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