Differential Diagnosis for Sickle Cell Disease Patient with Knee Pain, Fever, and High Inflammatory Markers
- Single Most Likely Diagnosis
- Sickle Cell Crisis with Avascular Necrosis or Osteonecrosis: This is a common complication in sickle cell disease patients, where the sickled red blood cells cause vascular occlusion, leading to bone infarcts and necrosis, particularly in the femoral and humeral heads, but can also occur in the knee. The fever and high inflammatory markers can be associated with the crisis itself or a superimposed infection.
- Other Likely Diagnoses
- Septic Arthritis: Patients with sickle cell disease are at increased risk of infections, including septic arthritis, due to their compromised immune system. The presence of fever, high inflammatory markers, and knee pain makes this a plausible diagnosis.
- Osteomyelitis: Another infection-related complication that could present with fever, elevated inflammatory markers, and localized pain, in this case, in the knee.
- Do Not Miss Diagnoses
- Meningitis or Other Serious Infections: Although less directly related to knee pain, patients with sickle cell disease are at increased risk of serious infections, including meningitis. The presence of fever and high inflammatory markers necessitates consideration of these potentially life-threatening conditions.
- Pulmonary Embolism or Other Thrombotic Events: Sickle cell disease increases the risk of thrombotic events. While knee pain might not be the primary symptom, a pulmonary embolism or other thrombotic events could present with fever and elevated inflammatory markers, especially if there's associated musculoskeletal pain.
- Rare Diagnoses
- Bone Infarction Due to Other Causes: While avascular necrosis is common in sickle cell disease, other rare causes of bone infarction (e.g., due to antiphospholipid syndrome, vasculitis, or other hypercoagulable states) could potentially present similarly.
- Rheumatologic Conditions: Certain rheumatologic conditions, such as rheumatoid arthritis or lupus, can present with joint pain and elevated inflammatory markers. However, these would be less common in the context of sickle cell disease and the specific presentation of knee pain and fever.