Welcome to this month’s What’s Your Diagnosis Challenge! But before we begin, check to see if you got last month’s case on Ultrasound-Guided Pediatric Nerve Blocks in the Emergency Department: An Evidence-Based Update right.
Case Presentation: Pediatric Spinal Epidural Abscess: Recognition and Management in the Emergency Department
A 30-month-old girl presents by referral from her primary care physician for fever and refusal to walk…
The parents tell you there is no history of trauma. You note the girl is febrile, tachycardic, and crying. Upon examination, her right hip and knee are in flexion, and she cries when you attempt to extend her knee. You cannot identify an area of focal tenderness to palpation. When the patient is prompted to bear weight on her right lower extremity, she touches her toes to the floor but refuses to bear weight. What is the differential diagnosis? What laboratory and radiographic studies would be helpful in making the diagnosis?
You considered septic arthritis and osteomyelitis and obtained laboratory studies and a hip ultrasound. The patient’s CBC and CMP were unremarkable, but the ESR was 98 mm/hr and the CRP was 19.05 mg/dL. The ultrasound of the hip was normal, so you were concerned about osteomyelitis and obtained an MRI of the hip.
The MRI showed abscess of the quadrates lumborum, with SEA at L4-L5 level. Empiric IV vancomycin and ceftriaxone were initiated while a surgical consultation was obtained and plans made for the patient to go to the operating room. The patient underwent surgical drainage of the abscess and was discharged on intravenous antibiotics to complete a 6-week total course, after which, she returned to baseline.
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Last Updated on January 26, 2023