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Pseudoparalysis of the lower extremity in an infant
D J McLario1, L J Burton, R W Bruce
1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Septic arthritis in infants can present subtly. Emergency physicians must recognize limited joint motion and consider infection in young children with pseudoparalysis.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Orthopedics
Background:
- Septic arthritis is a joint infection requiring prompt diagnosis and treatment.
- Early recognition is crucial to prevent joint damage and systemic illness.
- Infants may present with non-specific signs, complicating diagnosis.
Observation:
- A previously healthy, afebrile four-month-old female presented with lower extremity disuse after trauma.
- Physical examination revealed isolated limitation of knee extension.
- No other significant findings were noted on initial assessment.
Findings:
- The case highlights a subtle presentation of septic arthritis of the knee in an infant.
- Pseudoparalysis and limited joint motion are key indicators in this age group.
- The absence of fever does not exclude serious joint infection.
Implications:
- Emergency physicians must maintain a high index of suspicion for septic arthritis/osteomyelitis in infants presenting with pseudoparalysis.
- Thorough physical examination, including assessment for joint effusion, is critical.
- Timely diagnosis and management are essential to optimize outcomes in pediatric joint infections.
Abstract:
We describe a case of septic arthritis of the knee in an afebrile, well-appearing four-month-old female. She had been evaluated previously for lower extremity disuse attributed to antecedent trauma. Her physical examination was remarkable only for limitation of extension of the affected leg at the knee. Emergency physicians should understand the physical examination findings suggesting joint effusion and the need to consider osteomyelitis/septic arthritis in children less than one year of age with pseudoparalysis.