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An unusual cause of limp
Mehdi Garbash1, Vidhooshni Rajamoorthy, Shrinavas Tambe
1Department of Paediatrics, Maidstone Hospital, Maidstone, UK. mehdigarbash@doctors.org.uk
BMJ Case Reports
|May 19, 2012
Summary
A child
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Rheumatology
- Pediatric Hematology-Oncology
Background:
- Limping is a frequent pediatric complaint, with non-traumatic limps occurring in 1.5-3.6 per 1000 children.
- Common diagnoses include transient synovitis, septic arthritis, osteomyelitis, Perthes disease, and fractures.
- The differential diagnosis for pediatric limp is broad and requires careful evaluation.
Observation:
- A 6-year-old girl presented to the emergency department with a limp.
- Her symptoms were initially attributed to common pediatric orthopedic conditions.
- Further investigation revealed an unexpected underlying diagnosis.
Findings:
- The patient was diagnosed with hemophagocytic lymphohistiocytosis (HLH).
- Limp is not a typical presenting symptom of HLH.
- This case highlights an atypical presentation of a rare pediatric condition.
Implications:
- This case underscores the importance of considering rare diagnoses even with common presenting symptoms.
- It challenges the typical understanding of HLH presentation in children.
- Clinicians should maintain a high index of suspicion for serious underlying conditions in pediatric limp cases.
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