Pediatric Septic Arthritis Differential Diagnoses
- Author: Richard J Scarfone, MD; Chief Editor: Russell W Steele, MD more...
The differential diagnosis of a painful monoarthritis is rather extensive. In contrast to children with septic arthritis (SA), children with transient synovitis appear well and are usually afebrile with just a mild limp. The American College of Radiology has established guidelines for the assessment of a limping child.
In adolescents, a slipped capital femoral epiphysis may manifest as a painful hip, thigh, or knee. Most patients are afebrile and the onset of pain may be preceded by minor trauma.
Legg-Calve-Perthes disease, which is most common in boys, afflicts children aged 4-8 years. In contrast to SA, the pain is subacute, with a more indolent onset, and these children do not have fever.
One study demonstrated that children with SA were less likely to have knee involvement, a history of a tick bite, or a fever than were children with Lyme disease. Additionally, median values of inflammatory markers were higher among those with SA; however, a large overlap was noted between the groups.
Aside from gonococcal arthritis or SA in the neonate, polyarthritis is not typically caused by bacteria in the joints. The differential for polyarthritis in children is broad and includes Lyme disease, acute rheumatic fever, serum sickness, Kawasaki disease, systemic lupus erythematosus, and Henoch-Schönlein purpura.
In a 2014 report from New Zealand, Mistry concluded that serological inflammatory markers and white cell count (WCC) on presentation differ significantly between children with acute rheumatic fever (ARF) and septic arthritis. Children with ARF displayed significantly higher erythrocyte sedimentation rate (ESR), higher serum C-reactive protein, and lower serum WCC than children with septic arthritis on presentation to hospital.
A study by Horton et al found that only 35% of cases of C difficile infection-associated reactive arthritis were correctly diagnosed by treating health care professionals and that five affected children (19%) were treated for presumed culture-negative septic hip arthritis despite having prior postantibiotic diarrhea and/or other involved joints.
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