Case23-:A9-Year-OldBoywithBonePain,Rash,andGingivalHypertrophy
一个9岁男孩，有骨痛、皮疹和牙龈增生
PresentationofCase
A9-year-oldboywithautismwasadmittedtothishospitalbecauseofpaininthehip,refusaltowalk,andtherecentonsetofarashandgingivalswelling.
一名9岁的自闭症男孩因臀部疼痛、不愿走路以及最近出现皮疹和牙龈肿胀而入院。
Thepatientwasinhisusualstateofhealthuntilapproximately3monthsbeforeadmission,whenhehadanupperrespiratoryillnesswithfever;shortlythereafter,hebegantohaverighthippain,tolimp,andtohavedecreasedenergy.Duringthenextseveralweeks,hebegantohavedifficultyclimbingstairs,becameincreasinglyirritable,andbeganmoaninginhissleepatnight;hisappetitedecreased,andhelost3.6kg.Magneticresonanceimaging(MRI)ofthehipsatanotherhospital7weeksbeforeadmissiontothishospitalreportedlyshowedmultifocalareasofhyperintensityinthebonesandbonemarrowedema.Atestforantinuclearantibodyfactorwasnegative;resultsofotherlaboratorytestsareshowninTable1.
患者入院前约3个月一直处于正常的健康状态，直到他患有上呼吸道疾病并伴随发热。不久，他开始有右侧臀部疼痛、不愿走路和精力下降。在接下来的几周中，他爬楼梯开始变得困难、变得越来越烦躁并且开始在晚上的睡眠中呻吟。他的食欲下降，体重减轻了3.6公斤。入院前七周，医院的髋部磁共振成像显示了多个区域的骨骼高信号和骨髓水肿。抗核抗体检测为阴性，其他实验室测试的结果列于表1。
Onemonthbeforeadmission,hesawanorthopedistatthishospital.Onexamination,therangeofmotionofbothhipswasnormal,althoughheseemedtohavepainattheendpointofabductionoftherighthip.Hewalkedwithawide-basedgait.Reflexeswerenormal.Therewerenopetechiae.Radiographsofthespineandpelvisshowednormalalignmentoftheboneswithoutfractureordislocation.Consultationwithaneurologistandahematologistwerescheduled;however,4dayslater,thesymptomshadmarkedlyworsened;heceasedplayingandrefusedtowalkorsitup,andhismothernotedarashonhislegs.Hewasadmittedtothishospital.
入院前一个月，医院看了一位骨科医生。检查时，尽管他的右髋外展终末时似乎有些疼痛，但双髋的活动范围正常。他以宽阔的步态走路。反射正常。没有瘀点瘀斑。脊柱和骨盆的X光片显示骨骼正常，没有骨折或脱位。已安排神经科医生和血液科医生会诊。然而四天后，症状明显恶化。他停止玩耍，不愿走路或坐起来，他的母亲注意到他的腿上有皮疹。医院。
Hedidnothavefever,nightsweats,dysphagia,nausea,emesis,dyspnea,cough,orchangeinurinaryorbowelhabits.Attheageof5months,