Seven-year-old girl with joint stiffness, abnormal gait, and eosinophilia

Abstract

HISTORY OF PRESENT ILLNESS A 7-year-old girl presented to the UCLA Pediatric Immunology clinic with a 1-year history of elbow and hand stiffness and abnormal gait. She had gradual onset of intermittent joint pain of the hands, elbows, and ankles, but no joint swelling, warmth, erythema, or morning stiffness. The pain was worse in the afternoon and aggravated by cold weather. The hands and feet were always characterized as being cool. The parents noted that her grip strength had decreased, making writing difficult. She had lost 15 pounds over 6 months despite a good appetite. Recently, she had started to walk with her feet facing outward. Her physician diagnosed a toe-out gait with tibial rotation. Initial laboratory tests showed a white blood cell count of 13,500 cells/ L with 32% eosinophils, a normal erythrocyte sedimentation rate (16 mm/hour, Westergren method), and a negative stool examination for ova and parasites. Past Medical History She wore corrective shoes for weak ankles when she was younger. Immunizations are current.