Metastatic Neuroblastoma Presenting as Suspected Septic Arthritis: A Case Report.
- 1College of Medicine, University of Sharjah, Sharjah, ARE.
- 2Division of Pediatric Hematology and Oncology, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, ARE.
Abstract
Neuroblastoma is the most common extracranial solid malignancy in childhood and can present with a wide range of clinical manifestations. Although metastatic disease frequently involves the bone and bone marrow, musculoskeletal symptoms may mimic common orthopedic conditions, resulting in diagnostic delays. We report a case of a previously healthy two-year-old boy who presented with a three-week history of bilateral lower limb pain, limping, intermittent fever, and abdominal pain. Initial evaluation raised suspicion for septic arthritis due to elevated inflammatory markers and magnetic resonance imaging (MRI) findings suggestive of hip infection. Hip aspiration yielded turbid inflammatory fluid containing numerous pus cells. However, cultures remained sterile, and the patient showed persistent symptoms despite broad-spectrum antimicrobial therapy. Further evaluation with whole-body MRI revealed diffuse bone marrow signal abnormalities involving the axial and appendicular skeleton, together with a right suprarenal mass, findings highly suspicious for metastatic neuroblastoma. Subsequent positron emission tomography/computed tomography performed at an external institution demonstrated widespread skeletal involvement, further supporting the suspicion of metastatic neuroblastoma. Tissue diagnosis was not obtained at our institution because the family elected to pursue further evaluation and treatment abroad. This case highlights the importance of reconsidering the diagnosis in children with presumed musculoskeletal infection who fail to improve as expected. Persistent fever, sterile cultures, anemia, elevated inflammatory markers, and multifocal musculoskeletal symptoms should prompt consideration of malignancy and early multidisciplinary evaluation.
Related
- Melioidosis Presenting as a Solitary Liver Abscess With Culture-Negative Septic Arthritis: A Case Report
- Group A Streptococcal Septic Arthritis and Osteomyelitis Presenting As Acute Rheumatic Fever: A Diagnostic Dilemma
- Late-Onset Group B Streptococcal Septic Arthritis of the Shoulder and Proximal Humeral Osteomyelitis Presenting With Reduced Spontaneous Arm Movement in an Afebrile Infant
- Association of Postoperative Stress Hyperglycemia Ratio with Suspected Infection, Culture Positivity, Sepsis, and Septic Shock in 1408 Patients After Cranial Neurosurgery
- A COJEC-chemotherapy resistant model of Th-ALK(F1174L)/MYCN neuroblastoma offers insights into tumour immune evasion and development of the bone marrow metastatic niche
BibTeX
@article{aljubeh2026metastatic,
title = {{Metastatic Neuroblastoma Presenting as Suspected Septic Arthritis: A Case Report.}},
author = {Rayan Aljubeh and Christeen Sourial},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117640},
url = {https://europepmc.org/article/MED/42999906},
note = {CC BY},
}
RIS
TY - JOUR
TI - Metastatic Neuroblastoma Presenting as Suspected Septic Arthritis: A Case Report.
AU - Rayan Aljubeh
AU - Christeen Sourial
PY - 2026
DA - 2026/10/08
JO - Cureus
DO - 10.7759/cureus.117640
UR - https://europepmc.org/article/MED/42999906
AB - Neuroblastoma is the most common extracranial solid malignancy in childhood and can present with a wide range of clinical manifestations. Although metastatic disease frequently involves the bone and bone marrow, musculoskeletal symptoms may mimic common orthopedic conditions, resulting in diagnostic delays. We report a case of a previously healthy two-year-old boy who presented with a three-week history of bilateral lower limb pain, limping, intermittent fever, and abdominal pain. Initial evaluation raised suspicion for septic arthritis due to elevated inflammatory markers and magnetic resonance imaging (MRI) findings suggestive of hip infection. Hip aspiration yielded turbid inflammatory fluid containing numerous pus cells. However, cultures remained sterile, and the patient showed persistent symptoms despite broad-spectrum antimicrobial therapy. Further evaluation with whole-body MRI revealed diffuse bone marrow signal abnormalities involving the axial and appendicular skeleton, together with a right suprarenal mass, findings highly suspicious for metastatic neuroblastoma. Subsequent positron emission tomography/computed tomography performed at an external institution demonstrated widespread skeletal involvement, further supporting the suspicion of metastatic neuroblastoma. Tissue diagnosis was not obtained at our institution because the family elected to pursue further evaluation and treatment abroad. This case highlights the importance of reconsidering the diagnosis in children with presumed musculoskeletal infection who fail to improve as expected. Persistent fever, sterile cultures, anemia, elevated inflammatory markers, and multifocal musculoskeletal symptoms should prompt consideration of malignancy and early multidisciplinary evaluation.
SN - 2168-8184
ER -