Novel Case Of Childhood Onset Finger Locking

Abstract

TREATMENT AND OUTCOME: -Testosterone 200mg IM injection -Two weeks later, patient noted scrotal pain and was found to have testicular cyst on ultrasound. He noted less fatigue and more energy within one week of treatment.-Vitamin D 50,000 IU qwk x 8 wk -Patient noted improvement during treatment with return to baseline after cessation. He was then continued on Vitamin D3, 2000 IU, twice daily for maintenance. (No relationships reported)HISTORY: JN was a 20 mo male whose right leg became entangled in the crib rails. Limp ensued, followed by 1 week history of refusal to bear weight on R leg. He had a 1 month history of subjective daily fevers. He was recently diagnosed with a pre-eruption cyst, in light of gum discoloration.MEDICAL HISTORY: 36 weeks GA, eczema, feeding problems, multiple food allergies, iron deficiency anemia, pica, FTT, humerus fracture. Diet-rice cereal, rice, ground beef, beans. Dev-appropriate. Imm UTD.PHYSICAL EXAMINATION: Vitals: Temp 36.7 C, Wt 9.08 kg(<5%), Ht 76 cm (<5%), Head circ 49 cm (75%), BP 106/60 Playful and interactive. Irritable during R leg exam. No edema, ecchymosis, erythema or increased warmth. Neurovascularly intact. Actively moving lower extremities. Tenderness to palpitation-R tibia. Discomfort with passive weightbearing on R leg. Periodontal disease with dark discoloration and active bleeding. DIFFERENTIAL DIAGNOSIS: Septic Joint, Osteomyelitis, Leukemia, Fracture, Nonaccidental Trauma, Scurvy TESTS AND RESULTS: HSCRP 0.4, ESR 26, lead 1.3, CMP grossly wnl, prealb 15, iron 11, TIBC 507, % sat 2, ferritin <5, Marked microcytosis, Wbc 12.7, Hbg 8.8, Hct 28.6, plts 361, 64% neut, 5% mono, 3% eos, 6% mononuclear atypical lymphs, MCV 52.3, RDW 23, retic 23.7(ref 28-36), Urine and blood cultures -no growth.Skeletal survey: healing proximal R humerus fracture. R Knee radiographs: Edema in the soft tissues of knee, possible minimal periosteal reaction at distal R femur metaphysis. No linear lucency. Blood pool scan: increased uptake over the R ankle and distal R femur. Gallium scan-wnl.The patient was readmitted 2 wks later for refusal to bear weight on the L leg. L leg radiographs, blood pool scan, gallium scans -wnl. Vitamin C <0.1 (ref 0.4-2) FINAL WORKING DIAGNOSIS: ScurvyTREATMENT AND OUTCOMES: A long leg cast was placed for presumed healing R femur fracture. DCF cleared JN to return home. 2 wks later, JN was readmitted for refusal to bear weight on the L leg. Amino-acid based formula was initiated. He received 1 week inpatient ascorbic acid supplementation. He was discharged on Poly-Vi-Sol. He was pulling to a stand and crawling. Approximately 1 wk later, he ambulated without limp. Periodontal disease resolved thereafter. He returned to full toddler activity without symptom recurrence.