Unusual case of recurrent bony pain and swelling in a child: a case report

Abstract

Prolonged fever in children is a vexing problem. High grade fever with multiple joint pain and swelling can be seen in infections, inflammatory conditions, connective tissue disorders and malignancies. Peri articular pain and fever can be seen in enthesitis, osteomyelitis and malignancy whereas articular pain can be seen in hereditary arthropathies, infectious and inflammatory conditions. Arthritis is defined as presence of pain, swelling, rednness, warmth and diminished range of motion. Involvement of more than four joints is taken as polyarthritis. Tuberculosis is an important differential diagnosis in this situation. Here we present a case of a 11-year-old boy with complaints of prolonged fever of 5 months duration with progressive pain, swelling and restriction of mobility of multiple joints. Investigations to rule out inflammatory arthritis, malignancy and infections were done in this child which were initially not pointing to a specific diagnosis. At times, even after best efforts, microbiological diagnosis cannot be established and we have to resort to advanced imaging, techniques and rely on a constellation of clinical and radiological, cytological and microbiological clues to clinch the diagnosis.