A Rare Cause of Diffuse Forearm Swelling in an Infant.

Abstract

1. Matthew Baker, MD* 2. Stephanie Todd, MD, FAAP†,‡ 3. Narendra S. Shet, MD†,‡ 1. *Children’s Hospital Los Angeles, Los Angeles, CA 2. †George Washington University School of Medicine, Washington, DC 3. ‡Children’s National Hospital, Washington, DC A 10-month-old previously healthy girl presents to the emergency department with new-onset fevers and progressive right forearm swelling, pain, and irritability after a diagnosis of a distal forearm fracture in the same arm 2 weeks earlier. Per the parents’ report, they initially sought care 2 weeks earlier when the child refused to bear weight with the right arm while crawling without any known history of trauma. Outside imaging was reported to be notable for nondisplaced distal radial and ulnar fractures, for which the patient was splinted. Although the family denied a history of trauma, due to the unclear etiology of the fractures, an evaluation for possible nonaccidental trauma was performed that was unrevealing, except for the noted radius and ulna fractures. Follow-up 1 week later had revealed a swollen forearm with repeated plain radiographs that demonstrated abundant periosteal reaction along the distal radius and ulna, presumably representing evidence of healing nondisplaced fractures given the duration since the initial injury (Fig 1). The arm remained swollen but compressible and nontender on examination. Due to the fever, as well as continued swelling of the right distal arm with decreased mobility and worsening pain and irritability, the parents present to …