Ruptured Appendicitis and Retrocecal Abscess Masquerading as Knee Pain in a Pediatric Patient: A Case Report

Alan G Shamrock; Morgan L Bertsch; Heather R Kowalski; Stuart L Weinstein

doi:10.1016/j.jemermed.2019.03.049

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Ruptured Appendicitis and Retrocecal Abscess Masquerading as Knee Pain in a Pediatric Patient: A Case Report

Journal article

Peer reviewed

Ruptured Appendicitis and Retrocecal Abscess Masquerading as Knee Pain in a Pediatric Patient: A Case Report

Alan G Shamrock, Morgan L Bertsch, Heather R Kowalski and Stuart L Weinstein

The Journal of emergency medicine, Vol.57(1), pp.e21-e25

07/2019

DOI: 10.1016/j.jemermed.2019.03.049

PMID: 31060848

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Abstract

Knee pain has a variety of etiologies in the pediatric population, including septic arthritis, osteomyelitis, fracture, ligamentous injury, and neoplasms. Extrinsic sources of knee pain may also be intra-abdominal, although abdominal pathology is much more likely to manifest as hip or proximal thigh musculature pain. A 5-year-old healthy male presented with atraumatic right knee pain, discomfort with weightbearing, fever, and elevated inflammatory laboratory markers. Physical examination and magnetic resonance imaging findings of the knee were benign, leading to low clinical suspicion for knee septic arthritis. Blood cultures were positive for a gastrointestinal organism, Granulicatella adiacens, suggesting abdominal pathology leading to referred pain. Ultrasound evaluation and computed tomography (CT) of the abdomen revealed a large abscess secondary to perforated appendicitis, which was treated with CT-guided drainage and i.v. antibiotics. The patient's musculoskeletal pain subsided with treatment of the appendicitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute appendicitis may present as knee pain, with other signs and symptoms mimicking septic arthritis, such as fever, inability to bear weight, and elevated inflammatory markers. Considering an array of differential diagnoses in pediatric patients with apparent knee septic arthritis is crucial to prevent delay in diagnosis of alternative infectious sources.

Appendicitis - complications

Carnobacteriaceae - pathogenicity

Humans

Abdominal Abscess - drug therapy

Child, Preschool

Knee - abnormalities

Magnetic Resonance Imaging - methods

Tomography, X-Ray Computed - methods

Male

Abdominal Abscess - complications

Anti-Bacterial Agents - therapeutic use

Appendicitis - diagnosis

Blood Culture - methods

Radiography - methods

Knee - physiopathology

Pain - physiopathology

Abdominal Abscess - diagnosis

Carnobacteriaceae - drug effects

Pain - etiology

Pain, Referred - diagnosis

Pain, Referred - physiopathology

Details

Title: Subtitle: Ruptured Appendicitis and Retrocecal Abscess Masquerading as Knee Pain in a Pediatric Patient: A Case Report
Creators: Alan G Shamrock - Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Morgan L Bertsch - Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Heather R Kowalski - Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Stuart L Weinstein - Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Resource Type: Journal article
Publication Details: The Journal of emergency medicine, Vol.57(1), pp.e21-e25
DOI: 10.1016/j.jemermed.2019.03.049
PMID: 31060848
NLM abbreviation: J Emerg Med
ISSN: 0736-4679
eISSN: 2352-5029
Publisher: Elsevier Inc; United States
Language: English
Date published: 07/2019
Academic Unit: Stead Family Department of Pediatrics; Orthopedics and Rehabilitation
Record Identifier: 9984040567602771

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3 Times Cited - Web of Science