Chronic limping in childhood, what else other than juvenile idiopathic arthritis: a case series

Abstract

Background: Limping is a common clinical symptom in childhood; different clinical conditions may lead to limping and the diagnosis of the underlying cause may often be a challenge for the pediatrician.

Case presentation: We describe the clinical manifestations, radiological pictures and disease course of other causes of limping in childhood, through a case series of seven cases and a brief discussion of each disease.

Conclusions: although trauma is the most common cause of acute limping, when there is no history of traumatic events and the limping has a chronic course, Juvenile Idiopathic Arthritis is usually the most likely clinical diagnosis. However, other some rare conditions should be taken into account if JIA is not confirmed or if it presents with atypical clinical picture.

Keywords: CACP syndrome; COPA syndrome; Chronic nonbacterial osteomyelitis; Differential diagnosis; JIA; Limping child; Lyme arthritis; Neuroblastoma; Non-traumatic limping; Pigmented villonodular synovitis.

Fig. 1

Longitudinal scan showing effusion in the capsule of the left coxo-femoral joint (blue arrow) with synovial thickening (orange arrow)

Fig. 2

Chest X-ray with diffuse interstitial thickening (a); pulmonary CT with diffuse marked thickening of the pulmonary interstitium with ground-glass areas especially at the lower lobes. At the subpleural level, bilaterally, tiny cystic formations associated with bronchiolectasias (b)

Fig. 3

CT cone beam: inhomogeneous bone thickening of the branch and of the right mandibular angle associated with erosive areoles (a); left ankle X-Ray with osteolytic lesion of the tibial metaphysis (b)

Fig. 4

X-Ray of the right knee: multiple radiopaque, round, loose bodies within the joint (a). Arthroscopy during synovectomy: multiple white, shiny loose bodies were within the articular space (b)

Fig. 5

Chest x-ray: flask appearance of the cardiac shadow due to pericardial effusion

Fig. 6

270 cc of blood serum from knee arthrocentesis performed after 2 months of limping

Fig. 7

MRI of the right knee with proton density-weighted axial view showing hyperplasia of the synovium and low signal intensity indicating hemosiderin (arrow)