Semeiology--a well established and challenging paediatric speciality

"This week's mystery comes from seven-year-old Callum from Middlesex who, when walking a variable distance, develops an ache around the knees and down his calf of such severity that he has to stop, when it disappears immediately. He also used to wake at night complaining of 'pains in the leg' when younger. This has now improved. This is a most puzzling case, as the relationship to exercise is strongly suggestive of interruption of the blood supply or claudication, though this would not explain the nocturnal pain. Callum has been investigated from top to toe by paediatric specialists, who have been unable to reach a diagnosis. So he, and his mum, will be more than grateful if anyone out there has any suggestions." (Dr James Le Fanu, Doctor's Diary, Daily Telegraph, 2 April 2002)