Red Book Online Presents: Diagnosis Detective | January 2025
Editor: Kristina A. Bryant, MD, FAAP
Case contributed by Matthew Peworchik, MD, Vanderbilt University Medical Center
A 9-year-old female presents to the emergency department with a three-day history of limping and right hip pain, and a one-day history of fever to 101o F. She has not had other symptoms or any preceding illness. The child had returned to the United States one week earlier following a 4-month trip to Somalia to visit her family. While on her trip, she ate freshly slaughtered meat prepared by her family and drank unpasteurized camel milk. The child's mother declined routine vaccinations for the patient starting at 32 months of age.
On physical exam, the patient avoids putting weight on her right leg when walking. Rotation of the right hip joint is limited. An ultrasound of the right hip shows a joint effusion; MRI shows no evidence of osteomyelitis or myositis. The right hip effusion is aspirated and returns grossly bloody fluid with 2099 nucleated cells/mcL (91% mononuclear). Cultures of the blood and synovial fluid are obtained and are negative at 48 hours. The child is discharged after 48 hours with her symptoms attributed to transient synovitis, but she is recalled the next day as the synovial fluid is now growing bacteria.
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