Clinical Review Lesson of the week

A painful hip as a presentation of Guillain-Barré syndrome in children

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7279.149 (Published 20 January 2001) Cite this as: BMJ 2001;322:149
  1. Tjun Tang, student doctor (tyt20@cam.ac.uk)a,
  2. Charles Noble-Jamieson, consultant paediatricianb
  1. a School of Clinical Medicine, Box 111, Addenbrooke's Hospital, Cambridge CB2 2SP
  2. b West Suffolk Hospital, Bury St Edmunds IP33 2QZ
  1. Correspondence to: T Tang, Queens' College, Cambridge CB3 9ET
  • Accepted 5 April 2000

Guillain-Barré syndrome should be part of the differential diagnosis of children with painful lower limbs

Pain of the lower limb in children is a symptom of many conditions and can lead to diagnostic difficulties; the clinician may search for a musculoskeletal rather than a neurological cause. Guillain-Barré syndrome must be considered when a child presents with pain of the lower limb. Misdiagnosis is more common in the paediatric population because the child's history and cooperation in the neurological examination are often limited. Failure to diagnose Guillain-Barré syndrome and to initiate prompt treatment is potentially life threatening as the disease can quickly lead to respiratory failure and death from muscle paralysis. We describe a child with Guillain-Barré syndrome who initially presented with a painful hip.

Case report

A two year old boy presented with pain in his right leg. Three weeks earlier he had had tonsillitis, fever, and diarrhoea. His doctor had treated him with amoxycillin, and his symptoms subsequently settled. The pain in his leg started two days before admission. He limped and was reluctant to walk. The pain was precipitated by walking and was vaguely localised to the hip. He had no other joint symptoms or relevant history. On examination he was apyrexial but irritable. He had difficulty sitting and refused to stand or weight bear. Neurological examination revealed intact cranial nerves, although the gag reflex was depressed, which was partly attributed to his uncooperative behaviour. However, there was no indication …

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