Abstract

NOBRE, Susana; LARANJO, Gabriela  and  SANTOS, Elisabete. Limping and bone pain - three different cases. Nascer e Crescer [online]. 2011, vol.20, n.3, pp.127-131. ISSN 0872-0754.

Musculoskeletal symptoms occur in benign diseases (infectious, inflammatory, orthopedic), and in cancer. We describe three cases with similar clinical presentation (bone pain/limping), but two different diagnoses. Case 1. A twenty month-old girl was observed for limping and right leg pain for twenty days. Right calcaneus palpation was painful with local swelling and redness. Laboratorial tests showed normal cell blood count and sedimentation rate and elevated lactate dehydrogenase (LDH). Bone scintigraphy and magnetic resonance (MRI) confirmed calcaneus osteomyelitis. Case 2. A five year-old boy was observed for fever, limping and right knee pain. Right anterior tibial tuberosity palpation was painful. He had neutrophilia, elevated C-reactive protein and LDH. Blood smear was normal. It was isolated Streptococcus pyogenes in blood culture. Suspecting osteomyelitis, intravenous antibiotic treatment started. However, bone scintigraphy suggested anterior tibial tuberosity osteoblastic lesion. MRI suggested knee marrow infiltration (leukemia/infection?). He performed a bone marrow exam which was normal. He completed six weeks of antibiotic treatment with infection resolution. Case 3. A five year-old boy was observed for limping and left foot pain. He had recurrent episodes of arthralgia/myalgia of lower limbs for four months, unresponsive to non steroid anti-inflammatory drugs. He showed slight swelling of tibiotarsal joint and painful palpation of left foot dorsum. Laboratory tests were normal in the previous week, but when repeated showed ane­mia and lymphocytosis. Initial blood smear was normal, but three days after, revealed 27% blasts. Acute lymphoblastic leukemia was confirmed by bone marrow exam. Malignancy should be evoked in children with musculoskeletal complaints even if at onset of the disease clinical manifestations are nonspecific and laboratory tests are normal.

Keywords : limping; bone pain; leukemia; osteomyelitis.

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