A 3 years old with bilateral knee swelling and inability to walk

Dr Ira Shah

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A 3 year old with bilateral knee swelling and inability to walk

Dr Ira Shah.

Medical Sciences Department, Pediatric Oncall, Mumbai.

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Medical Sciences Department, Pediatric Oncall, Mumbai

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Clinical Problem
Case Report: - A 3 year old boy presented with swelling over both knees, dorsum of feet and inability to walk since 3 months. He has fever, headache and irritability since 7 days. Child had a history of fall 3 months back following which he is unable to sit and walk. He was treated by an orthopedic surgeon with oral medications and plastering of right knee for 21 days. His milestones and immunization are upto date. His diet is poor and consists of only tea and chapatti. There is no rash, bleeding from any site on TB contact. On examination, he was pale and had beading, frontoparietal bossing with pedal edema. Both knees and ankles were swollen and tender with increased local temperature and had painful restricted movements. He had frog like position. There was no oral bleeding. He was also malnourished (Wt = 9 kg, < 5th centile; Height = 89 cm, < 5th centile). Other systemic examination was normal. Child was started on oral medications and showed a dramatic improvement in 48 hours.

What is the diagnosis?

Discussion
Expert’s opinion: - Dr Ira Shah
This child is unable to walk and sit though the neurological examination is normal. Although the child has swollen knees and ankles, it is extremely painful to even move the limb. Thus neurological causes of paraplegia seem unlikely. One may consider juvenile arthritis, leukemia and scurvy as differential diagnosis here. However, leukemia seems unlikely as the child has had these symptoms for more than 3 months and has not developed any other problems such as organomegaly, lymphadenopathy or bleeding or weight loss. Juvenile arthritis is less likely as there seems to be no history of early morning stiffness and the child tends to keep in limbs in a frog’s position which is very unusual position for a synovial joint effusion. This child has a diet which is very poor in vitamins and minerals, has beading, frog like position and pseudoparalysis which is highly suggestive of scurvy (vitamin C deficiency). Supplementation with high dose Vitamin C leads to dramatic improvement in a couple of days. This child had scurvy and responded dramatically to Vitamin C supplements.

Compliance with ethical standards

Funding: None

Conflict of Interest: None

Cite this article as:
Shah I. A 3 years old with bilateral knee swelling and inability to walk. Pediatr Oncall J. 2007;4: 18.