14-month-old diagnosed with Kingella septic arthritis - was the initial management reasonable ?
I’m looking for some opinions from doctors because I’m struggling to process what happened with my 14-month-old son. I’m wondering whether his management was reasonable or whether I should consider making a complaint to the first hospital he was at.
It started after he had hand, foot and mouth disease. About a week later he developed a limp and wouldn’t fully bend one knee. The limp continued for about a week and actually seemed to get worse rather than better, so I took him to hospital.
He was admitted to a regional hospital where they did blood tests, an X-ray and an ultrasound. The ultrasound showed fluid in his knee and his inflammatory markers were raised (CRP initially around 30). The working diagnosis was transient synovitis, although they said they couldn’t completely rule out septic arthritis.
Over the next 5 days in hospital:
- He continued limping and I didn’t notice any real improvement.
- His knee remained swollen.
- He developed a fever (38.4).
- His CRP increased to around 50 before starting to slowly come down again.
- His white cell count actually went down.
They kept saying he could still move the joint and bear some weight, so they felt septic arthritis was less likely.
They discussed MRI but it kept getting delayed.
I repeatedly expressed that I was uncomfortable with the uncertainty because he wasn’t improving. I asked whether he should be transferred to the children’s hospital for a paediatric orthopaedic opinion.
He was eventually transferred after getting an MRI after 6 days in hospital. The children’s hospital took him to theatre, drained the knee and found pus. The culture grew kingella kingae, so it was confirmed septic arthritis. He had surgery and IV antibiotics and thankfully is now home and recovering well. He’s already walking again with only a slight limp.
From reading afterwards, I discovered that Kingella septic arthritis can present much more subtly than “classic” septic arthritis, with only mildly raised inflammatory markers and children sometimes still being able to walk.
My questions are:
- In hindsight, was the management at the first hospital reasonable, or should septic arthritis have been investigated more aggressively given the persistent limp, knee effusion, raised inflammatory markers and fever ?
- Does identifying Kingella change how you view the first hospital’s decision making, given that it often presents atypically ?
- Would you consider a 6 day delay (not including the 48hrs to grow the bacteria) before diagnosis acceptable in a child like this, or is this something you would encourage me to discuss with the hospital or make a formal complaint about ?
I’m not looking to blame anyone unnecessarily. I genuinely understand that medicine isn’t always straightforward and that not every child presents like a textbook case. I’m just trying to understand whether this was an unfortunate, difficult diagnosis or whether my concerns should have been acted on sooner.
Also, if sharing this helps even one parent whose child has a persistent limp after what seems like a viral illness, please don’t ignore your instincts if they’re not improving. I kept being told it was “most likely” transient synovitis, but thankfully I kept pushing because something didn’t feel right.
Thanks in advance for any insight.