Recurrent leg pain with fever in 5 year old

[LD04]

My 5 year old son has had recurrent leg pain with fever up to 103 for the past five weeks. He will be fine for 2 or 3 days and then the symptoms come back.  Usually the pain first, then the fever.  The pain in his leg is anywhere from the crease of his leg to his knee area.  The pain will be in one leg and then the next time it will be in the other.  Two weeks ago the pain got so bad and had actually spread to his tail bone area in the sacral area, that he could not even stand up.  He was admitted to the hospital for 4 days on morphine to control the pain.  He had every blood test imaginable and a bone scan and MRI which all came back normal.  The only abnormal results were a C Reactive Protein of 7.5, a SED rate of 39 and then 79, and an LDH on 932.  He was released from the hospital after the pain and fever had subsided.  It has come back every couple of days since then, but only in the leg area with the fever.  His pediatrician said he felt it was from a build up of lactic acid in his system and to limit his activity.  We have significantly limited him, but with a little more than normal walking in a day, the pain and fever returns.  He has lost two pounds, but other than that, has a good appetite and is a healthy happy child.  The pain and fever comes on suddenly.  He will go from fine to miserable in minutes.  We're not buying the lactic acid build up, because of the fever that comes with the pain.  While he was in the hospital, he was seen by 5 doctors, a pediatric neurologist and a pediatric infectious disease specialist and they all found nothing.  The only thing they could come up with was a possible adverse reaction to his MMR vaccine which he recieved the end of August.  He had all his kindergarten shots on August 26.  It was the following week that his problems arose.  We are taking him back to the doctor tomorrow, because he has not improved.  His pain and suffering is terrible.  It will wake him from sleep during the night and he will grit his teeth and shiver from the fever.  Motrin seems to help relieve it, sometimes though he also needs tylenol with codeine to give him some relief.  What else can we do to find a diagnosis?  The doctors have basically diagnosed nothing.  Our son lives a very healthy and active lifestyle and this has come out of nowhere.  Other than the shots in August the only thing out of the ordinary was he cut his foot on a plastic gatorade bottle cap that dogs had been chewing on, which made it very sharp.  It cut quite deep, but no need for stitches.  That was during the summer at least 2-3 months ago.  He had also been seen by a chiropractor for a head tilt.  He had strabismus surgery about a year and a half ago, but within the last 6-9 months or so his head tilt came back.  His pediatric optomitrist said that his measurements were the same as right after his surgery, which had completely fixed the problem.  Thus the reason for seeing the chiro to see if he could fix it.  Please help!  No one can diagnose!

[Kevin Pho, MD]

Tough for me to say without examination, and it would be unlikely that I could come up with something that hasn't already been thought of, especially if there has been evaluation with 5 physicians.  

With the elevated C-reactive protein and sedimentation rate, I would look towards a rheumatological cause - such as a vasculitis.  These set of diseases are essentially inflammation of the blood vessels.  One possibility would be Kawasaki's disease - which is one of the most common vasculitidies in children.  This is manifested by fever, rash, enlarged lymph nodes and extremity changes, such as swelling.  

Typically, there is no test that can accurately diagnosis this disease - but evaluation by a rheumatologist would be helpful.  

To evaluate for other rheumatological disease, you may want to obtain an ANA level as well.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Babycakes1]

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[Mother Margaret]

Is there a possibility that one of the parents have CFS or CFIDS?   I am wondering about an autoimmune issue that can show up as a 'birth defect' only it's not present at birth ... and shows up later

I know a 'gulf war syndrome' vet who shares that his son who was born after his deployment to gulf war I has joint pain that the doctors can't figure out.

So, the chemical I suspect for their harm, and many in the general public is a teratogen, 2-butoxyethanol.

Would one of the parents have red blood cells that are immature? Is there blood in urine?

What is going on with your son's immune system?  I think a lab can study that.  Is there any blood in urine (probably not, if it is a 2nd or 3rd generation 'show up')

http://home.gci.net/~blessing/pages/discoveries.htm#2-b

http://home.gci.net/~blessing/pages/thefatigue.htm

http://home.gci.net/~blessing/pages/autoimmune.htm

[Hkyipa]

A related discussion, fever/leg pain in children was started.

[Hkyipa]

A related discussion, Answer needed was started.