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 you would like to suggest for a future Case Challenge, please contact us.
Background
A 3-year-old girl is brought to the emergency department by her parents with a fever and refusal to walk secondary to pain in her right leg. The pain is associated with thigh and back pain on the same side as the limp. The day before presentation, the child's mother picked her up from her babysitter, where she noticed that the child was irritable and crying. At that time, the child was pointing at and trying to touch her back, and she was walking with a noticeable limp. The parents called the patient's pediatrician, who recommended an antipyretic with follow-up the next day.
The review of symptoms is only remarkable for a 1-week history of a "cold" with a runny nose and a cough. The mother denies any history of trauma to the affected extremity, and there is no history of similar problems. The patient's medical history is unremarkable. The child is well-appearing and has been regularly observed by the outpatient pediatric department. The patient's immunization schedule is up to date. The child's developmental milestones are appropriate for her age. The family history is noncontributory.
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Cite this: Setshedi Makwinja, Ben Numpang, Benjamin R. Aubey. Fever and Limp in a 3-Year-Old Girl - Medscape - Oct 28, 2015.
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