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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
