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A 3-year-old male develops foot pain, gingival edema
A 3-year-old male living in Puerto Rico presented with progressive bilateral foot and lower extremity pain. He had been healthy until 4 months earlier, when he was diagnosed with influenza B. In addition to the common symptoms of influenza at that time, he also had the onset of pain in both feet. This pain continued, with a pattern of getting worse in the mornings, and reached a point where the patient refused to wear shoes. An orthopedic consultant failed to find a problem, and the patient was treated with pain medication, which had minimal effect. As his pain continued, he began having painful gingival swelling and erythema. His dentist referred him to a local hospital, where he was diagnosed with gingivitis and myositis, supported by an elevated CPK of 1760 and an ESR of 40, with a negative bone scan. The patient’s gingival edema worsened, with friable bleeding gums and ongoing leg pains, and he was taken to the regional medical center. Additional history revealed that he never had fever, night sweats or joint inflammation or swelling, but he did have a mild, transient rash, now resolved.