Pediatric Septic Arthritis Differential Diagnoses
- Author: Richard J Scarfone, MD; Chief Editor: Robert W Tolan Jr, MD more...
Diagnostic Considerations
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.[6] The American College of Radiology has established guidelines for the assessment of a limping child.[7]
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.[2] 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.
Differential Diagnoses
- Juvenile Rheumatoid Arthritis
- Kawasaki Disease
- Lyme Disease
- Rheumatic Fever
- Serum Sickness
- Transient Synovitis
Welkon CJ, Long SS, Fisher MC, Alburger PD. Pyogenic arthritis in infants and children: a review of 95 cases. Pediatr Infect Dis. Nov-Dec 1986;5(6):669-76. [Medline].
Thompson A, Mannix R, Bachur R. Acute pediatric monoarticular arthritis: distinguishing lyme arthritis from other etiologies. Pediatrics. Mar 2009;123(3):959-65. [Medline].
Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. Dec 1999;81(12):1662-70. [Medline].
Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. Jun 2006;88(6):1251-7. [Medline].
Kaplan SL. Challenges in the evaluation and management of bone and joint infections and the role of new antibiotics for gram positive infections. Adv Exp Med Biol. 2009;634:111-20. [Medline].
Taekema HC, Landham PR, Maconochie I. Towards evidence based medicine for paediatricians. Distinguishing between transient synovitis and septic arthritis in the limping child: how useful are clinical prediction tools?. Arch Dis Child. Feb 2009;94(2):167-8. [Medline].
[Guideline] Fordham L, Gunderman R, Blatt ER, et al. Limping child--ages 0-5 years. American College of Radiology (ACR). 2007;5. [Full Text].
Pääkkönen M, Kallio MJ, Peltola H, Kallio PE. Pediatric septic hip with or without arthrotomy: retrospective analysis of 62 consecutive nonneonatal culture-positive cases. J Pediatr Orthop B. May 2010;19(3):264-9. [Medline].
Print
