TY - JOUR T1 - Think about the ‘C’ (in custard and crackers) JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed DO - 10.1136/archdischild-2017-312993 SP - edpract-2017-312993 AU - Jane Metz AU - Izidora Holjar-Erlic AU - Alison Kelly AU - Athimalaipet, V Ramanan Y1 - 2017/11/09 UR - http://ep.bmj.com/content/early/2017/11/09/archdischild-2017-312993.abstract N2 - 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.CRMO was diagnosed at age 3. She’d had shoulder, knee, and ankle involvement, two courses of pamidronate (2011 and 2015) and was currently taking simple analgesia.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.Mild hypochromic anaemia, … ER -