A 17 years old male was admitted to the hospital , with complaints of fever, inability to walk, erythema, local swelling, and pain on the left hip for ten days. His medical history was unremarkable .
on the day of admission, physical examinationm revealed thet he was in pain and feverish. His physical examination was normal except the musculoskeletal component. Lower extremities were neurovasculary intact.local examination showed tehderness with increased local temperature, local swellingand erythema, and restricted movement on the left hip. Left hip abduction and external rotation were limited , but other join movement were full. Skeletal xray revealed multiple lytic lesions in pelvic bones and left femur . Laboratory findings included a hemoglobin level of 11, total leucocyte count of 254 and a platelet count of 2 . Erythrocyte sedimentation rate was 140 with a crp measuring 60. Antinuclear antibody and rheumatid factor were negative . The doctor planned to caryy out xray, bone scan, needle aspiration and bone biopsy
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