A3 year old boy is referred to you from a rural hospltattor on-going management of a painful and swollen left knee. He has been an in-patient at the other hospitaltor 5 days.
The treating General Practitioner’s referral letter states
“..he presented with a 2 week history of pain and limp. Sweling and warmth of the left knee was noticed. On admission the white cell count was slightly raised, ESR was 35, CRP 40, temperature 37.8 Celsius and radiographs of the left knee normal.
I aspirated the knee on the day of the admlsslon and obtained cloudy synovial fluid but no growth on culture. The child has not clinically improved despite intravenous Flucloxacillin. Repeat ESR and CRP remain about the same.
lam worried l am missing something. Thanks for your ongoing management..”
The parents are very worried about the lack of improvement and ask you some probing questionsin relation to the lack of a definitive diagnosis. They are openly critical of the management ot their child’s illness in the first hospital
Question 3 (30mins)
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