Comments on: What’s the Diagnosis #8

By: Clinton

Clinton — Thu, 25 Mar 2010 17:30:15 +0000

Septic arthritis immediately jumped to my mind — it’s unfortunate that the pediatrician disregarded the mother and neglected a thorough physical exam!

STARTS HOTT:
Septic arthritis
Toxic synovitis
AVN
RA (JRA)
Trauma
SCFE

HSP
Osteomyelitis
Tumor
TB

By: Matthew

Matthew — Thu, 25 Mar 2010 03:06:14 +0000

Sounds like a case study from class (MSII) last week. I’m guessing Rheumatic fever

By: Jane

Jane — Wed, 24 Mar 2010 23:02:37 +0000

Yeap, a septic hip. My nephew just had this. He got taken to emerg after complaining of hip pain for a few days that led to immobility. He went to the OR for washing, and antibx of course. Luckily all better now.

By: Vamsi Balakrishnan

Vamsi Balakrishnan — Wed, 24 Mar 2010 22:13:21 +0000

@Sarah G: “Silly question from an antibiotic n00b: what effect should the amoxicillin have had on the infection? If it isn’t the right drug, what would be?”

The amoxicillin would possibly treat the ear infection (first line treatment; if the bacteria are resistant, then use amoxicillin-clavulonate). The problem is, as I viewed it, I think the infection is secondary to the possible osteomyelitis (infection of the bone). http://goo.gl/iL0L (link to an explanation I buzzed).

You’d probably want to do a tap + culture to see what bacteria…and what resistances are there. I’m not positive, but…that’s what my limited knowledge would tell me to do. :-/

By: Sarah G

Sarah G — Wed, 24 Mar 2010 17:29:45 +0000

Silly question from an antibiotic n00b: what effect should the amoxicillin have had on the infection? If it isn’t the right drug, what would be?

By: leeM

leeM — Wed, 24 Mar 2010 16:53:05 +0000

Hmm, a haunting silence from Matt and other
lawyers.

Guess they are better at using the retroscpectoscope (sp?) when the final results are known…

By: Peter Griffin

Peter Griffin — Wed, 24 Mar 2010 16:36:09 +0000

Brain tumor. Excise brain for treatment. Jim, I’m a doctor, not a miracle worker.

By: William the Coroner

William the Coroner — Wed, 24 Mar 2010 15:15:53 +0000

Mine wasn’t any more sick than any of my other patients. Though that’s not saying much, she was a 14 year old.

By: April

April — Wed, 24 Mar 2010 15:07:43 +0000

Just to throw out another option, (I’m with Steve)…what about Legg-Calve-Perthes Disease? Sed rate can be elevated if the infection is present. It should at least be in the DDX.

By: Josh

Josh — Wed, 24 Mar 2010 13:13:21 +0000

Kind of another possibility, rheumatic fever? I know she only has pain in one joint, but the elevated sed rate, CRP, WBC, and joint pain could point to that. Guess would have to see if they have a rash or a prolonged PR on ECG, but it could be. By the way, not a doctor, but an ER tech about to start PA school.