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Related Experiment Video

Updated: Feb 2, 2026

Quantifying Learning in Young Infants: Tracking Leg Actions During a Discovery-learning Task

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Published on: June 1, 2015

Learning from tragedy: the Julia Berg story.

Mark L Graber^1,2, Dan Berg³, Welcome Jerde³

¹Society to Improve Diagnosis in Medicine, 5 Hitching Post, Plymouth, MA 02360, USA.

Diagnosis (Berlin, Germany)

|November 15, 2018

Summary

A diagnostic error involving Epstein-Barr virus infection led to a teen's death. This case highlights cognitive biases in medicine and the importance of accurate diagnosis to prevent patient harm.

Keywords:

Epstein-Barr viral infection diagnostic error

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Area of Science:

Medicine
Pathology
Medical Education

Background:

A 15-year-old girl presented with symptoms including fatigue, fever, sore throat, and flank pain.
Initial evaluation focused on suspected gallbladder disease, leading to hospitalization and surgery.
The patient experienced unexplained post-operative complications and subsequently died.

Observation:

Computed tomography (CT) scan revealed an abnormal gallbladder with elevated bilirubin and liver function tests.
Repeated laboratory tests showed a significant lymphocytosis.
Autopsy and further testing suggested Epstein-Barr virus infection with acalculous cholecystitis as the correct diagnosis.

Findings:

The initial diagnosis of cholecystitis/cholangitis was incorrect.
Epstein-Barr virus infection with acalculous cholecystitis was identified post-mortem.
Cognitive biases may have contributed to the diagnostic error by diverting attention from key symptoms and lab findings.

Implications:

This case underscores the critical need to consider a broader differential diagnosis, including infectious causes.
It highlights the impact of cognitive biases on clinical decision-making and patient safety.
The family's advocacy has spurred initiatives to improve diagnostic error prevention and medical education.