A pediatric patient with severe hip pain after AOM and no signs of infection or fracture is most likely diagnosed with which condition?

• A. Septic arthritis
• B. Transient synovitis
• C. Legg-Calve-Perthes disease
• D. Slipped capital femoral epiphysis

Answer: (B)

Transient synovitis is a common cause of acute hip pain in children and often follows a recent viral illness. It involves a short-term inflammation of the hip joint with fluid buildup, producing pain and limping but leaving the child generally well-appearing without fever or systemic infection. In this vignette, the child has severe hip pain after an AOM but shows no signs of infection or fracture, making a self-limited inflammatory process of the hip the most likely explanation.

Septic arthritis would present with fever, a toxic look, and markedly abnormal inflammatory markers, requiring urgent evaluation and drainage. Legg-Calvé-Perthes disease typically has a gradual onset of hip or knee pain in younger children and shows a more insidious ROM limitation. Slipped capital femoral epiphysis occurs in adolescents, often with obesity, and pain is not characteristically linked to a preceding infection.