Description

The patient is a 21-month-old girl who presents with a two-day history of progressive, painful, swelling in the left hand and in the right foot with dactylitis, occurring one week after a URI. She now refuses to bear weight or use her hands. Physical exam is also significant for scleral icterus, splenomegaly, and a flow murmur. She has had similar but milder, self-resolving episodes in the past for which she was not seen by a doctor. As the patient is an adoptee from Haiti, no family or birth history is available.