Septic arthritis and transient synovitis (pediatrics) Quiz: Ace Your Exams

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A 4-year-old boy is brought to the emergency department because of difficulty walking. The patient’s parent states that, due to leg pain, the patient has been limping for the past two days, and today he refuses to walk. He has had fever, malaise, and poor oral intake over the past three days. The patient has no significant past medical history and does not take any medication. He is up-to-date on vaccinations. Weight is 62^nd percentile and height is 45^th percentile. Temperature is 39°C (102.2°F), blood pressure is 75/32 mmHg, pulse is 144/min, respiratory rate is 32/min, and oxygen saturation is 97% on room air. The patient is ill-appearing and uncomfortable. Examination of the right leg reveals an effusion of the right knee with overlying erythema and warmth. There is limited passive and active range of motion of the right knee due to pain. Examination of the left leg is normal. There are 2+ dorsalis pedis pulses bilaterally. Which of the following is the most appropriate management?

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Intravenous clindamycin

Intravenous vancomycin and cefepime

Intravenous methylprednisolone

Intraarticular glucocorticoids

Intravenous cefepime