 |
|
|
|
|||||||||||||||||||||
|
||||||||||||||||||||||||
 |
||||||||||||||||||||||||
|
|
|
|
|
|
 |
|||||
|
brilliantbaby.com the website that can help you have a happy, smarter child. |
|||||
|
Fever and Leg pain A 5 year old girl was brought to a doctor because of left leg pain and on and off fever for six days. Five days before, she was brought to an emergency room because of one day fever (102.9 F; 39.3 C) and pain at the left knee and thigh. She did not have any history of injury. Otherwise she is healthy. A blood count and ESR (erythrocyte sedimentation rate) were normal. She was diagnosed with “toxic synovitis.” Two days later, she was brought again to the emergency because of worsening left leg pain. A repeat ESR was now elevated to 37 mm/hour. Today she woke up with a fever of 105 F (40.5 C) with more pain at the leg. Complete flexion, extension, or rotation of her left hip is not possible because of pain. There is limited extension of her left leg. There was no swelling or redness in the left leg and the rest of the physical examination was normal. [Case Analysis: The main features of this girl are high fever, leg pain, and increasing ESR (Erythrocyte Sedimentation Rate). ESR is a measure of how fast the Red blood cells (RBC) settle or fall in an hour inside a vertically placed thin cylinder. The normal range is from 0 to 20 mm/hour. This child ESR is abnormal, 37 mm/hour which indicates inflammatory process or infection. A bacterial infection should be assumed because of high fever. This infection could be located at the belly (abscess), hip, leg, or knee. The following conditions should be considered: intra-abdominal abscess (psoas abscess), septic arthritis, and osteomylitis. A bone scan was done in this girl and it was positive. A regular x-ray of the leg will not show any abnormality in early bacterial infection. However, a technetium-99m bone scan may show abnormality in about 48 hours of an infection. MRI is extremely useful in targeting the diagnosis. This child has osteomyelitis.] Osteomyelitis is a serious infection of the bone usually from Staphylococcus aureus. Haemophilus influenzae type b is seen in children younger than 2 years old. Newborn and children with sickle cell disease and immunodeficiency are prone to Gram-positive infections. Children who stepped on a nail wearing a sneaker can have Pseudomonas infections. The usual treatment is intravenous for several days followed by antibiotic by mouth for about 6 weeks. The complications are: septic arthritis (joint infection), damage to the growth plate, spread of infection to other tissues, and fracture. Back Home Pertussis in a 5 month old. .Leo Leonidas, MD, FAAP |
|||||