A 7-Year-Old Boy With Left Hip and Knee Pain

Derik L. Davis, MD; Ogechukwu R. Menkiti, MD; Brighita Weinberg, MD

Disclosures

August 31, 2016

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 accurately recognize. 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

A 7-year-old boy presents to the emergency department (ED) complaining of left hip and knee pain and refuses to bear weight on his left leg. His mother reports that the child fell down in the street 2 days ago. The pain is described as mild to moderate in intensity. The patient denies any numbness or tingling in the distal left lower extremity. No skin laceration or bruising is reported by the family. Upon further questioning, the mother admits to having witnessed evolving symptoms over the past 2 months. She describes a worsening limp, decreasing mobility, and increasing left hip and knee pain, without any identified inciting trauma.

The patient was brought to the ED 10 months before this presentation for a similar episode of left knee pain after a vague history of a fall. At that visit, radiography of the affected knee demonstrated changes consistent with a mild form of unilateral left-sided juvenile Blount disease. The patient was given a prescription for a nonsteroidal anti-inflammatory medication as needed for pain control, and he was discharged without hospital admission. The symptoms resolved after only 3 days, and the child was asymptomatic for the following 8 months. The past medical history is remarkable for the use of an albuterol inhaler to treat intermittent episodes of asthma. The patient is also markedly obese. He has no previous history of surgery and no known drug allergies. The patient is up-to-date on his immunizations. The patient's mother denies any exposure of the child to cigarette smoke. The family history is noncontributory.

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