An 11-Year-Old Girl With Facial Swelling and Leg Pain

Jeffrey A. Toretsky, MD; Stefan Zöllner, MD

Disclosures

October 08, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

An 11-year-old girl presents with painful, nontender, right facial swelling. Aside from neonatal gastrointestinal intussusception, she has no history of severe disease and receives no long-term medication. She has multiple allergies, including nuts and hay fever.

The child developed the swelling, accompanied by recurrent night fever, 3 weeks before admission. Assuming an acute dental abscess, the attending dentist incised and drained the tissue and prescribed antibiotics.

The patient also has intermittent, severe, achy right leg pain that is relieved by acetaminophen; this had been diagnosed as a sprain at an outside emergency center. The mother recalls a trauma during a soccer game some weeks ago. The patient has also been experiencing ongoing fatigue over the past month. No other constitutional signs or symptoms, such as weight loss, night sweats, diarrhea, nausea, or vomiting, are noted. Her family history is unremarkable for cancer. Her brother has just recovered from an acute respiratory infection.

Because of progressive facial swelling, mild headache, ongoing fever, and persistent pain, the patient is referred to a pediatric specialist.

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