Pediatrics

Interactive Quiz: Joint Pain

  • Answer: Radiologic skeletal survey

    A radiologic skeletal survey showed periosteal reactions in both femurs and diffuse osteopenia but no fractures. She was discharged home without a diagnosis.

    After discharge, her joint pain and skin discoloration continued to worsen. The joint pain and stiffness began to involve her elbows and knees, and the skin discoloration spread to her wrists and elbows. Her only other illness was an uncomplicated upper respiratory tract infection. She had never traveled outside of the state, and her parents denied any trauma.

    On examination, the patient was small for her age but was well-appearing. She had reduced movement of her extremities and cried with any manipulation of the shoulders, elbows, wrists, knees, and ankles. No obvious joint swelling or erythema were present. It was difficult to fully extend at the shoulder, elbow, and knee, although slow passive range of motion was possible. Symmetric, brownish purple hyperpigmentation was present bilaterally over the metacarpophalangeal (MCP) joints, the lateral aspect of the wrists, the medial aspect of the elbows, the medial and lateral malleoli, and the proximal interphalangeal joints of the feet (Figures 1 and 2).

    Fig 1Fig 2

    A skeletal survey was performed, the results of which showed generalized slightly decreased bone density but no acute or healing fractures. Abdominal ultrasonography findings were normal. 

    She continued to appear to have significant pain with any manipulation of her extremities, which improved with the administration of morphine and ibuprofen.