Red Book Online Presents: Diagnosis Detective | February 2024
Editor: Kristina A. Bryant, MD, FAAP
Case contributed by Bennett Waxse, MD, PhD, National Institute of Allergy and Infectious Diseases/Children’s National Hospital
A 14-year-old previously healthy female presents with 11 days of right (R) elbow pain that worsened one night prior to presentation. The pain is worse with movement and radiates up the arm. She denies fever, chills, night sweats, redness or swelling. She was involved in an altercation at school within the last week, but she denies trauma or injury. She is sexually active with one male partner. Her mom reports that they are currently between homes in Maryland due to a problem with “mold spores.” She denies other exposures, including known tick exposure. The physical exam is notable for limited range of motion and an effusion. X-ray and MRI of the R elbow demonstrate a moderate R effusion without synovial hypertrophy or signs of osteomyelitis. Laboratory results are notable for neutrophilia and an elevated C-reactive protein. An arthrocentesis yields 10 mL of straw-colored fluid, with 25,562 nucleated cells (86% neutrophils). At 20 hours of incubation, the enrichment broth culture is positive for an organism that grows on sheep blood and chocolate agar.
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