A 6-Year-Old Boy Is Brought to the Office for Evaluation

A 6-year-old boy is brought to the office for evaluation of leg pain.  The pain has been constant for the last 2 weeks and keeps the patient from playing with his friends.  It is worse at night and has made it difficult for the child to fall asleep.  He wakes up several times nightly to void and has had episodes of incontinence as the leg pain prevents him from walking to the bathroom.  The patient has had no recent fever or dysuria.  Temperature is 36.7 C (98 F) .  Cardiac examination reveals tachycardia; no murmurs are present.  A soft, non-fluctuant, tender, 5-cm (2.5-in) mass over the right anterior distal thigh without overlying erythema is noted.  The right knee has full range of motion, and no effusion is noted.  An erythematous, papular rash is present over the chest, trunk, and groin.  Laboratory results are as follows: Skeletal survey reveals a single small, well-defined, lytic distal femoral diaphyseal lesion.  Which of the following is the most likely diagnosis in this patient?

A) Langerhans cell histiocytosis
B) Multiple myeloma
C) Osteogenesis imperfecta
D) Osteoid osteoma
E) Osteomyelitis
F) Osteosarcoma

Correct Answer:

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