Pediatric unilateral knee swelling: a case report of a complicated differential diagnosis and often overlooked cause

Abstract

Lyme disease is the most common vector-borne illness in the United States. However, Lyme arthritis is a diagnosis that is often missed, even in children, who are the population with the highest incidence of Lyme disease. Lyme arthritis, which presents in the later stage of Borrelia burgdorferi infection, needs to be recognized and managed promptly, especially in endemic areas or when exposure to ticks is known. We present a case of a 3-year-old female presenting to the emergency department with a history of limping for 2 weeks. The mother of the child recognized a tick bite. However, the child was not taken to seek care expeditiously, because she had not developed any rashes. Test results demonstrated that the patient was IgG positive and IgM negative for Lyme disease, with Western blot confirming the diagnosis of Lyme arthritis. Most patients presenting with Lyme arthritis do not recall having a tick bite, making it difficult to differentiate it from other pediatric conditions. When this diagnosis is missed, it can result in long-term morbidity, which is generally refractory to intravenous antibiotic therapy, oftentimes requiring synovectomy. Hence, this underscores the importance of the consideration of Lyme arthritis as a differential diagnosis in patients presenting with joint effusion.

Sensory integration from an occupational therapy perspective

“…2 It should be noted that Sensory Integration stands out for being a Framework of Reference conceptualized by Jean Ayres, addressing the principle of intersensory integration as being fundamental to the individual's function, while dysfunction at this level leads to alterations in development, learning and emotional regulation. 3 It is based on the concept of neuroplasticity, since the nervous system changes in response to experiences in the environment. Thus, intervention based on this framework involves guided involvement through sensorimotor activities incorporated into the baby and child's main occupation, i.e.…”

“…playing, thus promoting neuroplastic changes leading to adaptive behaviors in relation to the experiences provoked during the intervention. 3…”

Effectiveness of Sensory Integration Therapy on Functional Mobility in Children With Spastic Diplegic Cerebral Palsy

“…Sensory integration explains the process by which the nervous system turns sensory data into action. The limbic system, as well as the vestibular and proprioceptive mechanisms, may be impacted by registration and modulation issues [ 15 , 16 ]. The sensory data from bodily movement across the area is handled by the vestibular system.…”

“…The sensory data from bodily movement across the area is handled by the vestibular system. According to Ayres' theory, the vestibular system controls the way one may respond to a stimulus, and the vestibular nuclei register and interpret visual information [ 16 , 17 ]. SIT is a rehab-based method that emphasizes the therapist-child bond and makes use of game-based sensory and motor activities intended to enhance the interpretation and incorporation of sensations [ 18 , 19 ].…”

Effectiveness of Neurodevelopmental Treatment and Sensory Integration Therapy on Gross Motor Function, Balance and Gait Parameters in Children With Spastic Diplegia

“…It includes the method of conceiving and organizing such motor actions. It is a procedure that calls for the person to have knowledge of actions and objects, motivation, and intention [ 13 ]. Ideation (conceptualizing activities), motor planning, and implementation comprise Praxis, one of Ayres' key concepts.…”