Lowe Josh, Bridwell Rachel E, Matlock Aaron G, Cibrario Amber, Oliver Joshua
Emergency Medicine, San Antonio Military Medical Center, San Antonio, USA.
Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, USA.
Cureus. 2020 Jun 13;12(6):e8592. doi: 10.7759/cureus.8592.
Atraumatic limb pain and limp is a common pediatric presentation in the emergency department in the United States. In a majority of cases, these presentations are benign. However, in cases where pediatric patients are repeatedly presenting for atraumatic limb pain, further investigation is required. We present such the case of a 14-year-old female with acute worsening of progressive atraumatic knee pain who was found to have a Brodie's abscess, a subacute pyogenic form of osteomyelitis. This is a particularly challenging diagnosis, as it often presents with no associated symptoms such as fever or weight loss. The consequences of missing this diagnosis include permanent disability and potential amputation, but excellent outcomes can be expected for those who undergo timely surgical debridement and irrigation. We discuss the etiology, common presentations, and treatment of this rare but potentially limb-threatening disease in the hope that clinicians will consider this diagnosis in cases of persistent or progressive atraumatic limb pain.
非创伤性肢体疼痛和跛行是美国急诊科常见的儿科病症。在大多数情况下，这些症状是良性的。然而，对于反复出现非创伤性肢体疼痛的儿科患者，需要进一步检查。我们报告了一例14岁女性患者，其进行性非创伤性膝关节疼痛急性加重，结果发现患有布罗迪脓肿，这是一种亚急性化脓性骨髓炎。这是一个特别具有挑战性的诊断，因为它通常不伴有发热或体重减轻等相关症状。漏诊的后果包括永久性残疾和潜在的截肢，但对于那些及时接受手术清创和冲洗的患者，可以预期有良好的治疗效果。我们讨论了这种罕见但可能危及肢体的疾病病因、常见症状和治疗方法，希望临床医生在遇到持续性或进行性非创伤性肢体疼痛的病例时会考虑这一诊断。
