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A 6-year-old girl presents with bilateral lower leg swelling, progressive fatigue, and ultimately, refusal to walk secondary to severe pain, which began a month ago. She had a respiratory illness along with mouth sores one month prior to development of these symptoms. There is no history of fever, rash, travel or sick contacts. Family history is significant for leukemia, breast cancer, colon cancer, and osteoarthritis.

She is afebrile and has normal vital signs. Her lower extremity examination shows non-pitting edema over both ankles and knees. There is no tenderness or crepitus on palpation of her lower extremities. She moves her lower extremities spontaneously when lying in bed and has normal strength. She has pain with full extension of knees as well as with dorsiflexion...

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