Picture of the Month Quiz
A 12-year-old boy with nonverbal autism
developed a 2-month history of petechiae and bruising followed by
worsening musculoskeletal pain and refusal to walk. There was no
preceding history of trauma, fever, or visible joint swelling. On
physical examination, he was pale and agitated. His lower limb
range of motion was limited, and he maintained 90° flexion of
both knees and external rotation of his left hip with refusal to
ambulate. Petechiae and bruising were noted on his lower
extremities, and gingival bleeding (
Figure) and alopecia were noted. Investigations
revealed microcytic anemia, a low serum iron level, and normal
white blood cell and platelet counts. The erythrocyte sedimentation
rate was elevated (46 mm/h; reference range, 1-10 mm/h).
Radiographs of the legs demonstrated only soft-tissue swelling and
osteopenia. Dietary history revealed longstanding restricted food
preferences limited to yogurt, pasta, oatmeal, and water.
For a complete discussion of this month's case, read the Picture of the Month—Quiz Case.