An unusual cause of limp

Abstract

Limp is a common clinical presentation in children, seen both in acute and community practice. The incidence is thought to vary between countries with suggested figures between 1.5 and 3.6 cases of non-traumatic limp per 1000 children. The authors present a case of a 6-year-old girl who attended our accident and emergency department with limp. It has been suggested that the most common diagnoses in our patient's age group are transient synovitis, septic arthritis, osteomyelitis, Perthe's disease and fractures or soft tissue injuries. Surprisingly our patient was diagnosed with haemophagocytic lymphohistiocytosis, for which limp is not a recognised presenting feature.

Figure 1

Bone scan showing area of abnormal uptake in right distal femur. Involves the medial femoral condyle and metaphysis on both sides of the medial growth plate.

Figure 2

MRI image showing marrow oedema in the medial aspect of the femoral metaphysis and the epiphysis.

Figure 3

Bone marrow trephine biopsy showing multiple foci of large histiocytes with prominent haemophagocytosis (arrows). Residual haematopoiesis is reduced. There is an excess of plasma cells and eosinophil precursors. (H&E stain: x40 original magnification).