SHM Converge Scientific Abstract ePoster Gallery-Is It Growing Pains? Bilateral Leg Pain After Sports

Pdf Summary

A 12-year-old Caucasian boy with no major medical history presented with 6 days of bilateral leg pain after playing soccer. He had experienced similar episodes over the prior three years, previously labeled as “growing pains.” He had no constitutional symptoms, but family history was notable for a mother who carried beta-thalassemia and a father who carried HbS disease.<br /><br />Examination showed tenderness over both distal femora. CBC was largely normal except for mild microcytosis. Imaging revealed concerning bone lesions: left femur X-ray showed endosteal scalloping and patchy lucencies with ill-defined margins, and MRI demonstrated subperiosteal fluid collections in both femora with a focal hyperintense lesion and peripheral enhancement in the right femur suggestive of bone infarction. Hemoglobin electrophoresis showed Hb S 62.5%, Hb A 24.3%, Hb F 8.6%, and Hb A2 4.6%, confirming HbS/B disease.<br /><br />The case highlights that “growing pains” is a diagnosis of exclusion and that recurrent limb pain should prompt a careful history, including family history, and appropriate workup. In patients with sickle cell disease or related hemoglobinopathies, bone infarction and osteonecrosis are important complications and may present with localized pain and abnormal imaging findings. In this patient, the combination of HbS/B disease and sports-related stress likely increased the risk of vaso-occlusive bone injury.<br /><br />Differential diagnoses included leukemia, bone tumor, aneurysmal bone cyst, osteochondroma, Gaucher disease, and bone infarction. The key lesson is to avoid dismissing recurrent limb pain as benign without considering hematologic disease.

Asset Subtitle

Enrique Konstat Korzenny

Meta Tag

Author List Alejandra Frauenfelder Sánchez, Athena Pefkarou, Enrique Konstat Korzenny, Silvia Carolina Escudero

Category Clinical Vignettes

Concept Growing Pains

Concept Bone Infarction

Concept Avascular Necrosis

Concept Diagnosis of Exclusion

Concept Hemoglobinopathy

Distinguished Finalist

Presenter Organization Nicklaus Children's Hospital

Presenting Author Enrique Konstat Korzenny

Track Pediatric

Keywords

growing pains

bilateral leg pain

sickle cell disease

HbS/B disease

bone infarction

osteonecrosis

hemoglobin electrophoresis

microcytosis

femur lesions

vaso-occlusive crisis

Growing Pains

Bone Infarction

Avascular Necrosis

Diagnosis of Exclusion

Hemoglobinopathy