6 yr old female brought to clinic for acute onset of left knee swelling and pain first noticed this morning. Only other symptom is vague abdominal pain and dry cracked lips. No significant family or PMH, not taking any medicstions, no trauma, no fevers or chills, no rashes. Exam benign besides large effusion. CBC unremarkable. Thoughts?

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Transient Synovitis/ Acute exacerbation of underlying pre existing JRA/ Haemocoagulopathic Arthritis, can be the probabilities in this 6 yrs. old female. A diagnostic aspiration is indicated and aspirated fluid should be examined for being a transudate or exudate.

The various differentials in this case are reactive arthritis, jra , haemophilia induced haemarthrosis though less likely since she is a female pt. Vague abdominal pain, cracked lips don't fit into the picture. So, we shd get a CBC, pti, pttk, esr, pbf done. Usg abdomen and knee shd be done because alongwith knee joint swelling, I think, the thigh is also hvng some swelling. Apart from the above mentioned beningn disorders, the other grave things are round cell tumors like Ewing's which shd be ruled out. Systemic manifestation s cn be a part of it. So, usg knee or if suspicion , MRI of the limb to rule out mass lesion.

Joint aspiration Gram stain and culture If positive,mini arthrotomy and lavage Otherwise usg evaluation to assess effusion and synovitis RA factor Uric acid Crp Esr Xray evaluation

Do usg of the knee first .reactive arthiritis/septic arthiritis

Advise aspiration of joint fluid Do microscopy and culture Sepsis profile Usg of joint Give symptomatic treatment No need to give antibiotic unless febrile

Effusion lt knee dd tubeculous synovitis dd monoarticular arthritis dd gout dd tumou de haemoarthrosis

Acute in onset no fever no trauma no family history left side only can suspect hemolytic problem . pls do PT APTT INR if deranged go through correction studies to factor.and deficient factor can be given .

Advise Diagnostic aspiration , usg of the knee,sepsis profile .


Agree w dr.sanjay sir

Thanks, Abhishek.
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