{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:20:28Z","timestamp":1773926428865,"version":"3.50.1"},"reference-count":3,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Educ Pract Ed"],"accepted":{"date-parts":[[2017,9,26]]},"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Case history<\/jats:title>\n                  <jats:p>A 9-year-old girl with autistic spectrum disorder (ASD) was admitted for a flare-up of chronic recurrent multi-osteomyelitis (CRMO). She complained of leg pain over 3 months, was unable to weight-bear and had a petechial rash for 10 days. She had bleeding gums and a long history of only eating custard and crackers.<\/jats:p>\n                  <jats:p>CRMO was diagnosed at age 3. She\u2019d had shoulder, knee, and ankle involvement, two courses of pamidronate (2011 and 2015) and was currently taking simple analgesia.<\/jats:p>\n                  <jats:p>On examination, she was afebrile, with a widespread petechial rash, most pronounced over her ankles\/shins. Her knees and ankles were tender; her ankles had small medial effusions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Investigations<\/jats:title>\n                  <jats:p>Mild hypochromic anaemia, normal platelets, white cell countand coagulation. CRP 16. Figures 1 and 2 show her knee radiograph and MRI, respectively.<\/jats:p>\n                  <jats:fig id=\"F1\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Figure 1<\/jats:label>\n                     <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"edpract-2017-312993f1\" position=\"float\" orientation=\"portrait\"\/>\n                  <\/jats:fig>\n                  <jats:fig id=\"F2\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Figure 2<\/jats:label>\n                     <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"edpract-2017-312993f2\" position=\"float\" orientation=\"portrait\"\/>\n                  <\/jats:fig>\n               <\/jats:sec>\n               <jats:sec id=\"s3\">\n                  <jats:title>Question\u00a01<\/jats:title>\n                  <jats:p>Give four differential diagnoses of petechial rash, bleeding gums and leg pain in an afebrile child?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s4\">\n                  <jats:title>Question\u00a02<\/jats:title>\n                  <jats:p>Name three behaviours associated with ASD with health consequences.<\/jats:p>\n                  <jats:p>\n                     <jats:italic>Answers to the questions are on page 02<\/jats:italic>\n                  <\/jats:p>\n                  <jats:p>ANSWERS TO THE QUESTIONS ON PAGE 02<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2017-312993","type":"journal-article","created":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T07:47:02Z","timestamp":1757231222000},"page":"304-306","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Think about the \u2018C\u2019 (in custard and crackers)"],"prefix":"10.1136","volume":"103","author":[{"given":"Jane","family":"Metz","sequence":"first","affiliation":[{"name":"Department of Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izidora","family":"Holjar-Erlic","sequence":"additional","affiliation":[{"name":"Department of Radiology, Bristol Royal Hospital for Children, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Bristol Royal Hospital for Children, Bristol & Royal National Hospital for Rheumatic Diseases, Bath, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athimalaipet, V","family":"Ramanan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Bristol Royal Hospital for Children, Bristol & Royal National Hospital for Rheumatic Diseases, Bath, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,11,9]]},"reference":[{"key":"2025090700465817000_103.6.304.1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2016-310911"},{"key":"2025090700465817000_103.6.304.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2014.12.003"},{"key":"2025090700465817000_103.6.304.3","unstructured":"Kliegman R , Marcdante K , Marcdante K , et al . Nelson Textbook of Pediatrics. 18th edition. Philadelphia, PA: Saunders, 1898."}],"container-title":["Archives of disease in childhood - Education &amp; practice edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2017-312993","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T07:47:03Z","timestamp":1757231223000},"score":1,"resource":{"primary":{"URL":"https:\/\/ep.bmj.com\/lookup\/doi\/10.1136\/archdischild-2017-312993"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,9]]},"references-count":3,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,11,20]]},"published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1136\/archdischild-2017-312993"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2017-312993","relation":{},"ISSN":["1743-0585","1743-0593"],"issn-type":[{"value":"1743-0585","type":"print"},{"value":"1743-0593","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,9]]}}}