Differential Diagnosis for Fever and Bone Pain in an Adolescent
Single Most Likely Diagnosis
- Osteomyelitis: This is a common cause of bone pain and fever in adolescents, often resulting from bacterial infection, typically Staphylococcus aureus. The infection can reach the bone via the bloodstream from other parts of the body or from direct inoculation due to trauma.
Other Likely Diagnoses
- Viral infections (e.g., influenza, COVID-19): These can cause bone pain (myalgia) and fever. The bone pain is usually diffuse and accompanied by other systemic symptoms like fatigue and cough.
- Growing pains: Although more common in younger children, some adolescents may still experience growing pains, which are recurrent pains in the legs, typically at night, without other symptoms like fever or redness.
- Stress fractures: Overuse injuries can lead to stress fractures, especially in adolescents involved in sports. These can cause localized bone pain and might be accompanied by fever if there's an associated infection, though fever is less common.
Do Not Miss Diagnoses
- Cancer (e.g., osteosarcoma, Ewing's sarcoma, leukemia): Although rare, these conditions can present with bone pain and fever. Early diagnosis is crucial for effective treatment, making them critical not to miss.
- Osteonecrosis (e.g., due to sickle cell disease): In patients with sickle cell disease, osteonecrosis can cause severe bone pain and may be accompanied by fever. It's a medical emergency requiring prompt treatment.
- Septic arthritis: While more commonly associated with joint pain, septic arthritis can sometimes present with adjacent bone pain and fever, especially if the infection spreads.
Rare Diagnoses
- Chronic recurrent multifocal osteomyelitis (CRMO): A rare condition characterized by recurring episodes of osteomyelitis, often without an identifiable cause. It can cause bone pain and fever and is more common in children and adolescents.
- Langerhans cell histiocytosis: A rare disorder in which the body accumulates too many immature Langerhans cells, leading to tissue damage. It can cause bone pain, fever, and other systemic symptoms.
- Bone cysts or tumors (e.g., unicameral bone cyst, aneurysmal bone cyst): These can cause bone pain and, if infected, fever. They are less common and usually diagnosed after imaging studies.