This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- Ahmad M. Suleiman, MD*
- Sangeeta Krishna, MD*
- Benjamin Katholi, MD*
- Kate Eshleman, PsychD*
- *Pediatric Institute, Cleveland Clinic Children’s Hospital, Cleveland, OH
AUTHOR DISCLOSURE
Drs Suleiman, Krishna, Katholi, and Eshleman have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Editor’s Note
This month, many people use Valentine’s Day as an opportunity to celebrate loving relationships. As seen in some of this month’s Index of Suspicion cases, though, sometimes health problems result from imperfect relationships. As pediatricians, we have the privilege of working for the best possible outcomes for children and their families.
Philip R. Fischer, MD
Associate Editor, Index of Suspicion
Presentation
A 12-year-old previously healthy girl is admitted to the hospital from an orthopedic surgeon’s office due to concern for osteomyelitis 2 weeks after an injury while playing soccer. She began having foot pain and erythema after her foot was stepped on during a soccer match. A radiograph of the foot taken on the day of injury was negative for fracture. During the 10-day period after the injury, she describes decreased ability to bear weight and progression of erythema and tenderness over her dorsomedial right foot. She and her mother also report consistent fevers at home, with the highest recorded at 103°F (39.4°C).
A sports medicine physician saw her on the tenth day after her injury. The complete blood cell count and C-reactive protein level at his office were normal. She was started on clindamycin for a presumptive diagnosis of cellulitis, and she was referred to orthopedics for further evaluation. She was seen by orthopedics 2 days later and was sent for admission to the hospital due to worsening erythema and inability to bear weight. She had taken 4 doses of clindamycin by the time of admission with no apparent improvement in symptoms. Her mother has pictures showing the progression of erythema along the foot …
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.
Log in through your institution
Pay Per Article - You may access this article (from the computer you are currently using) for 2 days for US$25.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.