Please read the case ONLY, and then comment on the following in the discussion board:  What are the main signs and symptoms you noticed? What initial possible diagnoses come to mind based on the signs and symptoms (try to think of at least 3 or 4 possibilities)? Share why you are considering each one of these diagnoses. Outside of the obvious of that we only have so much information to work with, what makes this case challenging?  Anything else jump out at you?