Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on Pediatric Apophysitis Management in the Emergency Department right.
Case Presentation: Management of Patients With Juvenile Idiopathic Arthritis in the Emergency Department
An 18-month-old girl is brought into the ED for refusal to bear weight…
- The mother says that the child has been limping for the past week. The limping is worse when the girl first wakes up and improves as the day progresses. Her mother denies constitutional symptoms.
- On examination, you note bilateral swollen knees and ankles, with an inability to completely flex or extend at these joints. The girl’s vital signs and the rest of her physical examination are normal. Upon further questioning, the mother also tells you the girl has been eating less.
- Laboratory work in the ED reveals mildly elevated inflammatory markers. Imaging with joint ultrasound reveals effusions and synovial hyperemia.
- Should you be concerned for a joint infection? Should you consider other testing such as synovial fluid analysis or magnetic resonance imaging?
Make your best guess, and check back next month for the case conclusion!
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