Case 1: Leg and Hip Pain in an 8-year-old Boy with Autism

Stephanie Marchant; Riaz Gillani; Janet Serwint

doi:10.1542/pir.2015-0071

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Stephanie Marchant, MD*
Riaz Gillani, MD^†
Janet Serwint, MD^†

^*United States Department of State, Washington, DC
^†Department of Pediatrics, Johns Hopkins University, Baltimore, MD

AUTHOR DISCLOSURE
Drs Marchant and Gillani have disclosed no financial relationships relevant to this article. Dr Serwint has disclosed that she receives grant funding for a quality improvement study on enhancing adolescent immunization rates in her role as CORNET network director. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

An 8-year-old boy with autism spectrum disorder presents with progressively worsening right hip and leg pain for 1 month. His mother describes the pain as initially self-resolving, sharp, and deep, followed by recurrent bouts of pain that are worse at night. He has no history of trauma. The pain starts in the right lower back and radiates to his groin. Review of systems is positive for occasional vomiting, sweating, swelling of the right leg, and a progressively worsening limp, with eventual refusal to bear weight. His family history is remarkable for juvenile idiopathic arthritis and inflammatory bowel disease.

Temperature is 36.7°C, pulse is 116 beats/min, respiratory rate is 24 breaths/min, and blood pressure is 98/70 mm Hg. Physical examination reveals a well-appearing, afebrile, normotensive boy with tenderness to palpation in the right lower abdominal quadrant without guarding or rebound; there is also swelling and tenderness to palpation of the right thigh without erythema. Pain is noted with right hip flexion, straight leg raise, and external rotation. There is 4/5 strength in the right leg/hip, 2/2 patellar reflexes bilaterally, and symmetrically intact motor and sensation in the lower extremities. Gait is antalgic, and the patient walks with an arched back and a notable limp.

Laboratory studies reveal a normal complete blood cell count, a normal differential count, and normal electrolyte values. The lactate dehydrogenase level is 1,081 …