Case 326: Intra-Articular Osteoid Osteoma.

Area of Science:

• Orthopedics
• Infectious Disease
• Pediatrics

Background:

• A 15-year-old male presented with activity-related left inner thigh pain.
• Initial laboratory results showed normal hemoglobin, platelets, and leukocytes, but low neutrophils and high eosinophils.
• Physical therapy yielded no improvement, and examination revealed significant hip pain and limited rotation.

Observation:

• Imaging studies and serologic analysis were pursued due to persistent symptoms.
• Positive immunoglobulin-G Lyme titers were reported, alongside normal inflammatory markers (C-reactive protein, erythrocyte sedimentation rate).
• A course of doxycycline was prescribed, leading to symptom resolution.

Findings:

• The patient experienced symptom recurrence weeks after completing doxycycline treatment.
• A second MRI of the left hip was performed four months after initial presentation.
• The case highlights the diagnostic challenges of Lyme disease presenting as hip pain in adolescents.

Implications:

• Early recognition and treatment of Lyme disease are crucial, even with atypical presentations.
• Recurrence of symptoms warrants re-evaluation and consideration of alternative or persistent diagnoses.
• This case underscores the importance of comprehensive diagnostic workups for pediatric hip pain.