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Clinical Case 20
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1

TG is a 3 year-old boy brought in to the acute care clinic for evaluation of refusal to walk and right hip pain. He was in his usual state of good health until he awoke from his nap this afternoon at daycare and refused to get off of his knapsack-- complaining that his right leg hurt. He is in daycare 3 days weekly and has had no sick contacts. He did have an upper respiratory illness last week which resolved without intervention. He has no past medical history and is on no medications. His examination is notable for a happy child in his father’s arms who becomes quite upset if his right leg is manipulated. Temperature is 38.0C.

He resists movement or palpation of the right leg from hip through the knee. There is no obvious bruising, rash or deformity. The remainder of his physical examination is normal. A complete blood count is normal. Westergren ESR is 15. Ultrasound of the hip shows a widened joint space.

Which of the following is the most likely diagnosis?
A)Legg-Calve-Perthes Disease
B)Munchausen’s by proxy
C)Septic arthritis of hip
D)Slipped capital femoral epiphysis
E)‘Toxic synovitis’ of hip







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