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Updated 27 August 2015

What's your diagnosis? – Case 25: swollen knee and fever

Mrs S takes her five-year-old son, Child A, to the doctor with a swollen left knee and a fever. Read the full case below and help to solve this week's case.

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Child A's fever started the night before. Initially Mrs S thought the child had a bout of flu, but she became very concerned when he did not respond to fever medication, kept on crying and complained about knee pain.

General weakness

Two days earlier Child A fell on the playground at school and sustained an abrasion wound on his left lower leg. Mrs S didn't make much of it as the wound was very superficial. Since the night before, the child has refused to walk, vomited twice, and appears generally weak.

Read: Nausea and vomiting

Child A has no medical or surgical history, is not allergic to anything and does not take any supplements or medication. 

On examination, the GP finds the following:

General:

Very irritated young child, warm to touch, refusing to walk, complaining about body pains

Chest exam:

Fast heart rate, lung fields clear

Legs:

Swollen left knee with decreased ability to bend. Warm to touch, and redder than the right knee.

The rest of the examination was normal.

Side Room:

Temperature: 39,3°C

Urine: clear

Heart rate: 155 beats per minute

Based on the above, what is the most likely diagnosis, and how would you confirm it? How would you treat the child?

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

What's your diagnosis? – Case 24: painful and swollen leg

Image: Sore knee from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.

 
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