Case 3: Fever, Limp, and Hip and Knee Pain in a 7-year-old Boy

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1. R. Claire Roden, MD* 2. Anat Feingold, MD* 3. Debrah Meislich, MD* 1. *Cooper University Hospital, Camden, NJ. A 7-year-old boy presents to the emergency department (ED) with a history of fever, limp, and pain at the right knee and hip. He had fallen from his bike 6 days earlier and landed on his left hip. The pain was initially localized to the right knee, but over the last 24 hours it has focused primarily in the right hip. Fever developed 2 days after his fall, with a peak temperature of 39.2°C (102.6°F). Four days ago, he was evaluated at another ED and discharged with a diagnosis of transient synovitis of the hip. Laboratory and imaging studies performed during that visit are not available for review. Since that time, his fever has persisted, the hip pain has worsened, he developed a limp, and now he refuses to bear weight on the right leg. He lives in a wooded area in southern New Jersey and has no known history of a tick bite or past history of Lyme disease. In the ED, physical examination reveals a pleasant and well-appearing boy. His temperature is 39.4°C (102.9°F), heart rate is 130 beats/min, respiratory rate is 22 breaths/min, blood pressure is 140/74 mm Hg (heart rate and blood pressure normalized after pain control), and oxygen saturation is 100% in …