Author: Moneef Hauter, MD
Editor: Margaret Gibson, MD, FAMSSM
Patient is a thirteen-year-old male who presented to the clinic with left leg pain of three weeks duration.
Left leg pain of three weeks duration. Pain was of mild intensity, 5/10 in severity and aggravated by walking. He had two prior episodes of pain that had resulted in office visits to other physicians. His symptoms were alleviated with NSAIDs. There were no other associated symptoms. Of note, patient suffered from severe eczema that prompted the treatment with cyclosporine, two months prior to onset of leg pain.
On Exam: Well developed, well nourished, and in no apparent distress. Neck supple. Normal breath sounds bilaterally. Normal heart rate and rhythm without murmurs. Normal bowel sounds, and normal gait. Hip exam: No deformities noted. No tenderness to palpation. Pain with passive left hip external rotation, otherwise normal. Normal knee range of motion. Normal ankle range of motion. Knee exam: no knee deformity noted. Subluxation of patella, and crepitus was noted in the knee joint, tenderness noted in the lateral joint line. Neurovascular exam was intact.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.