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Two year old boy with Hip pain A two year old boy was seen for right hip pain. The parents gave a history that three weeks earlier, he had tonsillitis, fever, and diarrhea. He was given amoxicillin and he got better. Two days before hospitalization he started limp which progressed to not being able to walk. On physical examination he was irritable but no fever. He do not want to stand or bear weight on his legs. He had trouble sitting also. Neurologic examination showed that he had a depressed gag reflex, and reduced reflexes of the biceps, triceps, and supinator muscles. Plantar and ankle reflexes were also diminished. When his right hip was flexed and extended he became distressed. An bone scan, ultrasound and X-ray of the right hip were normal. CBC (complete blood count), ESR (erythrocyte sedimentation rate), and C-reactive protein were normal. On the fourth day at the hospital he became more irritable and complained of more pain. He had pain on the neck, elbows, and wrist. He was weak, lethargic, and don’t want to walk. Sitting needs help. He was referred to a rheumatologist who found him with generalized limpness of the extremities and hypotonia. A neurologist also saw him found a soft, weak, high-pitched cry. On the 8th day, he had a test that revealed the diagnosis. Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.
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