Case 17: 4 yo refusing to walk

Question 1

Arthritis is the second most common manifestation of Lyme disease. When does it typically start?

Answer 1

4 weeks after the rash

Question 2

Does lyme disease usually affect small or large joints?

Answer 2

large

Question 3

What are some positive predictors for septic arthritis of the hip as opposed to a transient synovitis?

Answer 3

fever
non-weight bearing
ESR>40
WBC>12

(if you have all 4, it’s 93% predictive of septic arthritis)

Question 4

How can you diagnose a septic arthritis of the hip?

Answer 4

Start with an ultrasound to identify an effusion and/or guide a needle aspiration

Question 5

What will the characteristics of the synovial fluid be if there is a septic arthritis?

Answer 5

cloudly, turbid appearance
increased WBCs, mostly polymorphs
Low glucose
Gram stain may show bacteria

Question 6

What are the most common causative organisms for septic arthritis in kids?

Answer 6

staph aureus
strep (GBS in neonates, GAS and Strep pneumo if older)
HIB (if unimmunized)
Neisseria gonorrhea (adolescents)

Question 7

What is the management for a septic joint?

Answer 7

surgery to incision and drainage
IV antibiotics (prolonged course overall)

Question 8

What history will typically precede a transient synovitis of the hip

Answer 8

a viral infection

Question 9

What is the management for a transient synovitis?

Answer 9

rest and ibuprofen

Question 10

How long does it take for the pain of transient synovitis to resolve?

Answer 10

3-10 days

Question 11

True or false: there is no increased risk for arthritis in patients who have had transient synovitis?

Answer 11

true

Question 12

What main neoplasm should always be considered in a patient who is refusing to walk?

Answer 12

leukemia (replacement of the bone marrow by leukemic cells causes bone pain)

Question 13

Reactive arthritis is an inflammatory process associated with an infection outside the joint; most commonly in what systems?

Answer 13

GI or GU