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Hidden diagnosis behind viral infection: the danger of anchoring bias
  1. Kenji Iwai1,
  2. Kenichi Tetsuhara1,
  3. Eiki Ogawa2,
  4. Mitsuru Kubota3
  1. 1Division of Emergency Service and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
  2. 2Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
  3. 3Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
  1. Correspondence to Dr Kenichi Tetsuhara, tetsuhara-k{at}


Anchoring bias is one of the most common diagnostic biases that may lead to closed-minded thinking and could result in unnecessary tests, inappropriate patient management and even misdiagnosis. A 4-year-old boy was brought to the emergency department because of shaking chills. On the basis of bilateral swollen preauricular areas, high level of serum amylase and the prevalence of mumps, he initially received a diagnosis of mumps in spite of the shaking chills. However, blood culture turned out to be positive for two different kinds of bacteria. The patient finally received a diagnosis of polymicrobial bacteraemia resulting from suppurative appendicitis. We must consider and rule out bacteraemia in the differential diagnosis for patients who present with shaking chills, even in the presence of symptoms or information consistent with a more common viral infection such as mumps. In addition, intra-abdominal infection should be ruled out in the presence of polymicrobial enterobacteriaceae bacteraemia.

  • emergency medicine
  • medical management
  • infection (gastroenterology)
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  • Contributors KI designed the structure of this case report and wrote the initial draft of the manuscript. KT assisted in preparing and writing the draft. EO and MK also contributed to collection and interpreting the data regarding this manuscript. All authors critically reviewed and revised the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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