Multifocal Bone Pain, Fevers, and an Enhancing Clavicular Lesion in an 11-year-old Liberian Boy

Abstract

On physical examination he has a temperature of 100°F (37.8°C) and is tachycardic (heart rate, 118 beats/min) but normotensive. He appears ill and distressed. He has mild scleral icterus and nontender mild hepatomegaly. He has palpable tenderness over his reported pain sites. A 1 × 1-cm warm, soft mass is noted over the mid-shaft of his left clavicle. His laboratory results, shown in Table 1, demonstrate leukocytosis (white blood cell count, 17,700/μL [17.7×10⁹/L]), microcytosis (mean corpuscular volume, 75 µm³ [75 fL]), and reticulocytosis (absolute reticulocyte count, 143×10³/µL [143×10⁹/L]), along with an elevated C-reactive protein level (106 mg/dL [1,060 mg/L]) and erythrocyte sedimentation rate (36 mm/h).