Refusal to Walk: Getting to the Heart of the Matter

Case: A previously healthy 2-year-old female presented with 3 months of bilateral leg pain, difficulty walking, pallor, weight loss, intermittent tactile fevers, and finally refusal to ambulate. She had no history of trauma or joint swelling. On admission, bilateral X-rays of hips, knees, and ankles were normal. Labs were remarkable for microcytic anemia (hemoglobin 8.6), low iron levels and reticulocyte count, erythrocyte sedimentation rate > 140 mm, mildly elevated C-reactive protein (6.7 mg/dl), thrombocytosis, and mild coagulopathy. Her initial exam was notable for pallor, mild genu valgum with …