ABSTRACT 219

Abstract

Background and aims: Monoarthritis of the hip is an emergency condition which primarily suggesting septic arthritis and hemarthrosis. Some malignancies such as acute leukemia, neuroblastoma or tumors originated from retroperitoneal region can mimic hip arthritis. We report a case presenting with symptoms of monoartrhritis of the hip. Methods: Case A 4 ½ years old male child presented with intermittent fever and ongoing pain in right thigh for three days. It was learnt that he had fallen from table and leg splint was included two months ago. He has no complaints since then. On systemic examination, she had fever with minimal hepatosplenomegaly and had pain with restriction of movements on the right hip joint. Abnormal laboratory results revealed high levels of ESR and CRP with hemoglobin 10.5g/dl. Peripheral blood smear and bone marrow aspiration were normal. Lower extremity radiographes showed metastatic lytic lesions leading to cortical destruction. Abdominal USG and CT revealed a solid mass containing necrotic areas and calcification. The patient was considered as neuroblastoma with ten times higher than normal levels of urine vanil mandelic acid and serum neuron-specific enolase. Conclusions: Neuroblastoma is a poorly differentiated pediatric tumor in which majority of it originates in the abdomen or pelvis, though it may appear anywhere from the brain to the pelvis. The wide range of clinical presentations makes the diagnosis a challenge. The most common symptoms are due to a tumor mass or to bone pain from metastases. In majority of cases, it is not diagnosed until metastasized. Thus, a high index of suspicion is needed.