Abstract：
A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied nighttime pain, fever, or chills. Laboratory investigation revealed the following normal values: hemoglobin level of 15.6 g/dL (normal range, 13-16 g/dL), platelet count of 240 × 103/µL (normal range, 140-440 × 103/µL), and total leukocyte count of 7100 cells/µL (normal range, 4500-11 000 cells/µL). The percentage of neutrophils was considered low at 44% (normal range, 54%-62%), and the percentage of eosinophils was slightly high at 3.7% (normal range, 0%-3%). An anteroposterior radiograph of the left hip is shown. Physical therapy was initiated, with no improvement after 2 weeks of therapy. The patient was referred to an orthopedist for further evaluation. At physical examination, the patient endorsed marked left hip pain with hip flexion to 90°, limited internal and external rotation (5° and 15°, respectively), and antalgic gait favoring the left leg. Hip MRI and further serologic analysis were requested for further evaluation. Although the serologic testing was performed at an outside laboratory, the physician reported positive immunoglobulin-G Lyme titers, normal C-reactive protein level, and normal erythrocyte sedimentation rate. Pelvic CT was requested. The patient was prescribed a course of doxycycline (100 mg twice daily for 28 days), with reported resolution of symptoms 2 weeks after initiation of treatment. Three weeks later, the patient presented to our department with recurrent left hip pain, which was similar in severity compared with the initial presentation. A second MRI examination of the left hip was performed 4 months after the initial presentation.
摘要：
方法：一名15岁男性患者，有3周的活动引起的左大腿内侧疼痛病史，偶尔在休息时经历。病人否认夜间疼痛，发烧,或发冷。实验室调查显示以下正常值：血红蛋白水平为15.6g/dL（正常范围，13-16g/dL)，血小板计数为240×103/微升（正常范围，140-440×103/微升),和7100个细胞/微升的白细胞总数（正常范围，4500-11000个细胞/微升)。中性粒细胞的百分比被认为是低的44％（正常范围，54%-62%），嗜酸性粒细胞的百分比略高，为3.7％（正常范围，0%-3%)。显示了左髋关节的前后X线照片。物理治疗开始了，治疗2周后无改善。患者被转介给骨科医生进行进一步评估。在体检时,患者认可明显的左髋关节疼痛，髋关节屈曲至90°，有限的内部和外部旋转（5°和15°，分别)，和有利于左腿的止痛药步态。髋关节MRI和进一步的血清学分析需要进一步评估。尽管血清学检测是在外部实验室进行的，医生报告免疫球蛋白G莱姆滴度阳性，C反应蛋白水平正常,和正常的红细胞沉降率。要求盆腔CT。患者接受了一个疗程的强力霉素（100mg，每天两次，共28天），治疗开始后2周报告症状缓解。三周后,到我们科室就诊的病人反复出现左髋部疼痛,与最初的报告相比，严重程度相似。初次就诊后4个月，对左髋关节进行了第二次MRI检查。
