Breaking pains and arthralgias

Sir .—We wish to bring to the attention of the readers a cause of chronic myalgias and arthralgias among urban adolescents and describe here our observation of a patient in order to alert physicians and parents to this specific phenomenon. Patient Report .—A 9-year-old black male patient presented to the Diagnostic and Evaluation Clinic at Oklahoma Children's Memorial Hospital, Oklahoma City, with the chief complaint of muscle pains all over his body and multiple joint pains of several weeks' duration. He had been examined a month before at a local hospital emergency department for a stiff neck, and a knot on the left scapula and neck was treated based on the symptoms. The patient's mother said he felt somewhat better, but continued almost daily to complain of severe pains all over his body and joints. Review of the systems was noncontributory. Physical examination revealed normal musculoskeletal and neurological systems. The