A 9-month-old boy is brought to the office by his parents due to swelling of the feet and hands for the past day

A 9-month-old boy is brought to the office by his parents due to swelling of the feet and hands for the past day.
They first noted the swelling when the patient refused to hold his bottle of morning formula. He has also had poor
feeding and fussiness. The patient has had no preceding upper respiratory symptoms and no known sick
contacts. He was recently adopted from Nigeria, and his family history is not available. Vaccines are up to date.
Temperature is 38.3 C (101 F) and pulse is 150/min. On examination, the dorsal surfaces of the hands and feet on
both sides are swollen and tender to palpation. The remainder of the patient’s joints appear normal. He is unable
to grasp the examiner s hands due to restricted range of movement. No rash is seen on skin examination. X-rays
of the feet and hands reveal soft tissue swelling. What is the most likely cause of this patient’s presentation?

  • 0 A. Autoimmune arthr tis
  • 0 B. Hypertrophic osteoarthropathy
  • 0 C. lschemic necrosis of bone
  • 0 D. Microvascular occlusion
  • 0 E. Salmonella bone infection
  • 0 F. Staphylococcus bone infection

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