Case 2: A 10-year-old boy with leg pain and swelling.

Abstract

A previously healthy 10-year-old boy presented to the emergency department with a history of right leg pain following a fall on the soccer field. He described a two-month history of intermittent mild right leg pain, rated 3/10 to 4/10, which worsened after activity. Pain had awakened him at night over the past three weeks. He was more fatigued, although he remained able to keep up with his peers on a competitive soccer team. His mother noticed that he appeared to have lost weight, and he denied any fevers. That morning, he fell on the grass during a soccer practice and experienced severe right thigh and knee pain, with significant erythema and swelling. The pain was unresponsive to appropriate doses of acetaminophen and ibuprofen, and he was unable to bear weight due to the pain. He described the pain as sharp and 9/10 in intensity. Medical and family histories were noncontributory. The physical examination showed a slight boy (weight 10th percentile for age), with swelling and erythema of the right thigh. Pain was elicited with movement of the limb, and there was tenderness to palpation of the distal thigh and knee. The remainder of the physical examination was unremarkable. Further investigations revealed the diagnosis.