Patient's Query
Hello doctor,
My four-year-old daughter has been unable to bear weight for about five days. Her walking has improved slightly today; however, she is still experiencing gait and mobility issues. Her CRP has increased from 66 to 166 within 48 hours.
She also has a fever and remains unable to bear weight. An MRI of the spine was clear, as were ultrasounds of the hips and knees. Her white blood cell count is normal.
I am now worried about the possibility of cancer.
Please advise.
Thank you.
Hello,
Welcome to icliniq.com.
Thank you for sharing your concern.
Please try to stay reassured. I do not believe these symptoms are suggestive of cancer. It is more likely to be an infection, as children are prone to these. Another possible cause could be transient synovitis of the hip.
I kindly request that you send me all investigation reports, including the blood test results, MRI (magnetic resonance imaging), and ultrasound reports. Additionally, if you are able to share a short video of your child walking or attempting to walk a few steps, it would be very helpful.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
At this moment, I do not have access to the reports. I do know that her WCC is slightly elevated, and her CRP is 166. They are repeating the blood tests again now.
The MRI of the spine is normal, as are the ultrasounds of the hips and knees. I will record a video for you while she is walking.
But can you please reassure me, is there nothing to worry about, such as cancer?
Hello,
Welcome back to icliniq.com.
Yes, one thing I am fairly certain about is that this does not appear to be a cancer. May I ask what led you to think about this diagnosis? Has the doctor caring for your child mentioned this possibility?
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
No, they have not mentioned that. I had testicular cancer when I was 23, and I read on the internet that a rapid rise in CRP in children can, in rare cases, be associated with malignancy.
I also know that leukemia can present with fever and bone pain, so I became concerned when I came across that information.
Hello,
Welcome back to icliniq.com.
Please do not assume a rare diagnosis first; we should consider the more common causes initially. Share the investigation results with me, and I will give you my opinion. However, I am confident that this is not a cancer.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They are not suspecting it; however, I just can not help worrying, that is all.
Hello,
Welcome back to icliniq.com.
Do not worry, your child will be fine. Please share any results you receive.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They are going to do an LDF test just for my peace of mind, to put my worries to rest. But I suspect that if it were leukemia, something would have shown up on the FBE or other tests.
Hello,
Welcome back to icliniq.com.
The leukemia-derived factor for ALL (acute lymphoblastic leukemia) is, in my opinion, not required.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Is this testing for ALL-type leukemia? Are all other types of leukemia detected through the FBE panel?
Please advise.
Hello,
Welcome back to icliniq.com.
I believe FBE stands for full blood examination.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Yes, sorry. They are calling it a CBC (complete blood count) here.
Hello,
Welcome back to icliniq.com.
As far as leukemia is concerned, there are many types. However, in a five-year-old child, ALL is the most common form, which is why he is ordering the LDF (leukemia-derived factor) test.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Understood. Given that the blood tests are unremarkable (aside from the elevated CRP), this is reassuring, correct? ALL and AML would likely have shown abnormalities in the blood panel. Also, the clear MRI is reassuring as well.
Thank you again.
Hello,
Welcome back to icliniq.com.
You are right.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They said they may discharge her if they can’t find the source of the infection, but they will continue antibiotics.
Hello,
Welcome back to icliniq.com.
If you can send a video of the child walking, I can help you rule out some possibilities. I want to rule out transient synovitis of the hip, which can look like an infection but does not require antibiotics. It usually resolves on its own. On the MRI, there is bilateral hip effusion.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I will get the video for you as soon as possible. They also mentioned that it could be osteomyelitis.
Hello,
Welcome back to icliniq.com.
Yes, I will also keep my initial diagnosis as osteomyelitis.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Is there a way to test for it, or is it a process of elimination?
Hello,
Welcome back to icliniq.com.
Blood tests can provide an indication. Normal blood tests can help rule out osteomyelitis, but abnormal results do not provide a 100 percent diagnosis. They give a clue about the possibility of osteomyelitis. A confirmed diagnosis is made through X-rays of the affected area.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They have started giving antibiotics intravenously.
Hello,
Welcome back to icliniq.com.
I think that is good. That is the standard treatment for osteomyelitis. What are the WBC (white blood cell) and ESR (erythrocyte sedimentation rate) levels?
Kindly revert.
Patient's Query
Hello doctor,
Thank you for the reply.
The ESR was 8 when it was last checked, but my wife mentioned that no blood results have come back yet. In addition, blood cultures typically take another 24 to 36 hours.
Hello,
Welcome back to icliniq.com.
Yes, cultures usually take about 48 hours, but they are unlikely to be very helpful. Which part of the body is the child experiencing pain in?
Kindly revert.
Patient's Query
Hello doctor,
Thank you for the reply.
She generally points to her knees.
Patient's Query
Hello doctor,
Thank you for the reply.
My wife just told me that the blood results came back, and the ESR is 31.
Hello,
Welcome back to icliniq.com.
31 is elevated, but not excessively. What is the WBC or TLC (total leucocyte count)?
Please revert.
Patient's Query
Hello doctor,
Thank you for the reply.
So, ESR is 31, and CRP is 166, and all other values are normal. What does TLC stand for?
Hello,
Welcome back to icliniq.com.
It stands for total leucocyte count.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
White cells are 9 and leukocytes are 1.8
Hello,
Welcome back to icliniq.com.
If your report is correct, then with a WBC of 9, it is unlikely to be an infection.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
What can it be then?
Hello,
Welcome back to icliniq.com.
I am not sure, that is what I asked you. I need all the reports, including the MRI and ultrasound, as well as a video of the child walking. I have very little information to comment on the diagnosis at this stage.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I will send you a video later today when I get there, showing the toddler walking. The hospital will not provide the MRI and ultrasound reports until discharge. I am worried.
Hello,
Welcome back to icliniq.com.
It is not cancer, if that is what you are worried about.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Can it be osteomyelitis?
Hello,
Welcome back to icliniq.com.
It is possible, but very unlikely, as the ESR is not very high and the WBC is not elevated. Only the CRP (C-reactive protein) is significantly raised. In osteomyelitis, both the ESR and WBC are usually significantly elevated as well.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
So, does an ESR of 31 rule it out? Is a CRP of 160 the only marker that is significantly elevated? Will antibiotics help?
Could it be a localized infection or something autoimmune?
Please advise.
Hello,
Welcome back to icliniq.com.
Another thing, if a five-year-old child is able to walk, I would not keep osteomyelitis as my first diagnosis. Does an MRI of the spine cover the hips?
Kindly revert.
Patient's Query
Hello doctor,
Thank you for the reply.
What are the possibilities, in your opinion, Doctor?
No, only the ultrasound was done on the hips.
Hello,
Welcome back to icliniq.com.
I would still want to rule out transient synovitis of the hip. In transient synovitis, these markers can be elevated, the WBC count can be normal, and hip pain can sometimes be referred to the knee.
I am not sure; it is just a possibility. I cannot be certain without examining the child and reviewing the reports.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I have asked my wife to take a video of her walking.
Hello,
Welcome back to icliniq.com.
Please do send me.
Warm regards.
Patient's Query
Hello doctor,
Thank you for the reply.
The infectious disease team came to see her and spoke with my wife. Apparently, the MRI was taken from the top of her thighs up to her upper spine, so the hips were included. They are still not sure what it could be. The rheumatologist is coming today to assess her.
They do not think it is transient synovitis, but they are not certain. She walked better today, although they think that may be due to the Naproxen. They are also unsure what is causing the fevers.
What do you think, Doctor?
Hello,
Welcome back to icliniq.com.
If she is walking, it is unlikely to be osteomyelitis. Do you or your wife have any systemic or longstanding medical conditions?
Kindly revert.
Patient's Query
Hello doctor,
Thank you for the reply.
Not that we know of. An X-ray of her legs has also been ordered, and a physiotherapist is coming to see her as well.
Hello,
Welcome back to icliniq.com.
Great. The X-rays will help rule out osteomyelitis.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Could it be that she injured herself last week while doing splits and aerobics, and coincidentally picked up a virus, which is causing the fever? Could these be two unrelated issues happening at the same time?
She was coughing for about two to three weeks, about two months ago. Could that have been post-viral?
Please advise.
Hello,
Welcome back to icliniq.com.
A post-viral cause is a possibility. After a viral illness, there can be inflammation in the joints, which may lead to difficulty walking. However, the CRP would not usually be that high.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
What about a mosquito bite? She is walking much better. I just took a video, but I cannot send it through here.
Also, could it be an anal fissure? She sometimes passes blood in her stool. Could that be how the infection developed?
Please advise.
Hello,
Welcome back to icliniq.com.
Oh, an anal fissure? I am not sure. I have never heard of an anal fissure causing this in a child. I do not think it is a mosquito bite.
Considering that she is improving rapidly, I believe it could be something like transient synovitis.
Warm regards.
Patient's Query
Hello doctor,
Thank you for the reply.
She is walking uphill and doing everything. The doctors think the Naproxen could be masking her pain, which is why she is walking better.
Could that be the case?
Hello,
Welcome back to icliniq.com.
I do not think so. Naproxen is not that powerful. It is just that the exact diagnosis is difficult to determine. The symptoms do not clearly fit into any particular diagnosis.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They may discharge us without a definitive diagnosis?
Hello,
Welcome back to icliniq.com.
Yes, that might be possible. The human body is the most complex machine and is still not fully understood to this day.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I just spoke to the infectious disease team. They do not know; it is as simple as that. They have seen patients like this before, where everything eventually resolves on its own. There is nothing of major concern to them, as they cannot pinpoint it to any specific cause.
The rheumatologist will be speaking to us next. However, there is no strong family history of autoimmune disease. They briefly considered something along the lines of rheumatic fever, but again, it seems unlikely.
They will give her another course of IV antibiotics tonight. It also seems that the fever-free intervals have been longer today.
Hello,
Welcome back to icliniq.com.
I do not think antibiotics have a role here. If they are considering rheumatic fever, they should check anti-streptococcal antibodies or an ASO (antistreptolysin O) titre.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
So, it is consistent with transient synovitis, as the rheumatology team has just told us. They think we should take a step back from further investigations, as this presentation is quite consistent with what they have seen in other patients.
She has improved, which is the main thing. This is what the rheumatologist has just explained to us.
Hello,
Welcome back to icliniq.com.
I have felt from the beginning that it might be transient synovitis. Somehow, your description was the closest to this diagnosis. Not completely, but it seems to be the most fitting one.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They have stopped the antibiotics. I do not understand. I am waiting to speak with them.
Hello,
Welcome back to icliniq.com.
Why give antibiotics if it is not an infection?
Patient's Query
Hello doctor,
Thank you for the reply.
The doctor just came and spoke to me. They have decided to stop the antibiotics because antibiotics can sometimes mask an infection. The ones she was receiving were broad-spectrum and were commonly used for spinal infections, UTIs, and pneumonia.
They explained that if the infection flares up again, it may help them identify the source. For now, it is more of a wait-and-see approach. She may be discharged tomorrow evening, provided she has no pain when walking and no further fevers.
Hello,
Welcome back to icliniq.com.
I do not think she will need any antibiotics.
Warm regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I think you are spot on, Doctor. You even mentioned earlier that you did not think it was an infection, given the WBC count.
Hello,
Welcome back to icliniq.com.
I think the child is becoming better. That is all that matters
Patient's Query
Hello doctor,
Thank you for the reply.
Yes, her temperature was 98.24°F this morning as well.
Hello,
Welcome back to icliniq.com.
That is great. I think she is fine.
Patient's Query
Hello doctor,
Thank you for the reply.
They have just repeated the blood tests to check the FBE, CRP, and ESR to see if the levels have decreased.
Hello,
Welcome back to icliniq.com.
I would have done the same. I believe the levels will have come down.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I hope so! Her walking is much better, and she can run more now. She still has a wide-based gait; however, she is not becoming fatigued as quickly.
Hello,
Welcome back to icliniq.com.
A wide-based stance is more suggestive of a hip issue. It was most likely transient synovitis of the hip. Do not worry, it should resolve completely and very soon.
Warm regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I will keep you posted on the blood results, Doctor.
Hello,
Welcome back to icliniq.com.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
The CRP is still elevated at 160; the doctor mentioned it could be delayed in coming down.
Hello,
Welcome back to icliniq.com.
CRP can take up to a week to return to normal and usually starts to decrease after about 72 hours. Moreover, it is not just the absolute value that is important; it is the trend that matters.
Yesterday it was 166, and now it is 160. It has not increased, which is a good sign.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They will not discharge her until it starts to decrease. They said they will repeat the test again tomorrow morning. Sorry, yesterday it was 160, not 166.
Hello,
Welcome back to icliniq.com.
All right, no problem. I am confident it will decrease. If it were an infection, it would likely have increased further.
As I mentioned, the trend is more important than a single value.
Warm regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Yes, that is what the paediatrician said as well, she wants to see it trending down. They are also speaking with the radiologist to review the scans.
Hello,
Welcome back to icliniq.com.
Alright.
Patient's Query
Hello doctor,
Thank you for the reply.
The senior doctor from rheumatology came to see her. He confirmed that the issue is with her right hip based on the examination and the rotational movements he performed. He is unsure about the cause of the fevers and will leave that to the paediatrician to assess.
Hello,
Welcome back to icliniq.com.
Yes, as soon as you mentioned the wide-based stance, I was also confident about hip involvement.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
They suspect it is inflammation, as you mentioned, Doctor. They just do not know where it is originating from. They are repeating the blood tests tomorrow morning.
At this stage, they are still unsure of the exact cause.
Hello,
Welcome back to icliniq.com.
Do not worry. I think the markers will come down soon.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I hope so! If they drop overnight, she can go home tomorrow.
Hello,
Welcome back to icliniq.com.
Yes, let us see. Let us hope for the best.
You can always contact me if you need further help.
I hope this has been helpful.
Thank you.
Was this conversation helpful?
Answered byDr. Anuj Gupta
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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