5½-month-old Boy with Right Leg Swelling and Fever

Abstract

<P>This 5½-month-old boy was admitted with a 2-day history of right leg swelling and fever. There was no history of trauma. On admission, the parents had noted that the swelling had increased in the past 24 hours and that the skin over the knee had become erythematous. He was definitely using the right leg less than he had been. His past history was remarkable for eczema, which was being treated by a dermatologist. He was the 7-pound 11-ounce product of a full-term pregnancy to a 34-year-old gravida 2 para 2 female. The pregnancy, labor, and delivery were uncomplicated. Development was normal.</P><H4>Key Learning Points</H4><OL><LI>Infants who have severe eczema coupled with failure to thrive or chronic diarrhea should be suspected of having an immunodeficiency syndrome, particularly those involved with T cell dysfunction such as severe combined immunodeficiency or DiGeorge syndrome.</LI><LI>Conditions that produce rashes that may be confused with atopic dermatitis include histiocytosis, seborrheic dermatitis, psoriasis, or ichthyosis.</LI><LI>Thrombocytopenia may be the result of consumptive coagulopathy, splenic sequestration, peripheral destruction as seen in immune thrombocytopenic purpura (ITP), and bone marrow failure. </LI><LI>Wiskott-Aldrich syndrome is an X-linked immunodeficiency syndrome characterized by eczema, thrombocytopenia with small platelets, recurrent infections secondary to variable immunodeficiencies, and an increased incidence of malignancies and autoimmune phenomena.</LI></OL><H4>ABOUT THE AUTHOR</H4><P>Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.</P>