Erythema Nodosum - Pediatric Oncall

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question
I have a problem in a case which was admitted in my hospital on 06\05\06 with history of erythematous skin lesion over anterior aspect of both lower limb. Also there is fever and pain on both knee jt. My patient is 12 years old female, overweight. She had a history of URTI just 5 days before she developed this rash. The rash was painful, sudden onset, slight raised over skin. \There is h\o reccuent tonsilitis, but no h\o cough \weightloss\ night sweating \or moring stiffiness\ or Raynaud phenomena. Also there is no h\o trauma \drugs\diarrhea\or weakness neighter convlsions\no family history, any Rheumatological disease. On examination, conscious, not dyspnic\or tachypnic, no pallor or cyanosis. Vital signs stable. Systemic examination was normal, Skin examination was normal. Investigations CBC was normal LFT, RFT both were normal. Serology negative, CRP and Rheumatoid factor both positive, ASO and cold agglutination positive, LE cell negative, ANAB also negative, Tuberculin test negative, urine R\E and C\S both normal. The working diagnosis was erythema nodosum. We put the patient on Asprin anti-inflammatory dose, the patient had still no improvement. Sorry, I forget to inform you that abdominal USG and CT, both were normal. Thank you for help co-operation. Your friend Dr.Najat.
Answer
How are the joint pains? Since the child has rash as well as joint pains with positive RA factor, one needs to observe her and see if she continues to have persistence of symptoms over a period of time and fits into the criteria of JRA. What is her ESR? She needs to be continued on NSAIDS. If she is not responding to aspirin, one may consider naproxen. Back to All Questions

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