Refusal to Bear Weight in a 3-year-old Girl with Autism Spectrum Disorder

Allison E. Williams; Maanasi Mistry; Maria Widmann

doi:10.1542/pir.2019-0102

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Allison E. Williams, MD*,^†
Maanasi Mistry, MD*,^†
Maria Widmann, MD*,^†

^*UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA; and
^†University of Pittsburgh, Pittsburgh, PA

Address correspondence to Allison E. Williams, MD, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224. E-mail: williamsae2{at}upmc.edu

AUTHOR DISCLOSURE
Drs Williams, Mistry, and Widmann 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.

Presentation

A 3-year-old girl with autism spectrum disorder presents with bilateral knee swelling, lower extremity pain, and refusal to bear weight. Six weeks ago, she developed right ankle pain and limping, without swelling, erythema, or trauma to the joint. Over the next month, she developed bilateral knee pain and swelling, and refusal to bear weight. She has no joint swelling or abnormalities of the upper extremities. Review of systems is positive for intermittent lower extremity joint swelling, and erythematous papular rash of the lower extremities starting 2 days before presentation. There have been no recent fever, weight loss, viral symptoms, or dietary changes. She is otherwise healthy and fully vaccinated. Her family history is negative for hematologic and rheumatologic disorders.

On examination, she is nonverbal and upset by interaction with health-care providers. Her vital signs are normal. She is the first percentile for weight and the 15th percentile for height. She has a normal head, ears, eyes, nose, and throat examination, with no gingival changes or bleeding. Her cardiac and pulmonary examinations have no significant abnormal findings. She has bilateral knee swelling with limited passive range of motion. She will not participate in the examination to evaluate active range of motion. There is no erythema, warmth, or effusion of either knee. She appears to have tenderness to palpation of her bilateral distal femur and proximal tibia. Her upper extremity joints and bilateral hips and ankles have full passive range of motion, 5/5 strength, and are otherwise unremarkable without tenderness. She has a diffuse, erythematous, nonblanching, papular, and pinpoint rash of the bilateral lower extremities. She refuses to bear weight. Her …