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Question |
dear sir, There is this 8 year old boy admitted to my ward with polyarthritis for the past 5 days prior to admission and also fever for 4 days.On admission he had a severe arthritis involving bilateral ankle joint, knee joint,rigth elbow joint and also left metacarpophalengeal joint. CVS/RS/ABdo : normal LAb : TWC : 20.5, HB : 11g/dl, PLT : 605,000 ESR : 100 ANA : negative ASOT : negative blood C and S : no growth,Urine C/S : NG previous history of impetigo Xray of all joints were normal. Cxray : normal We treated him as Acute Rheumatic Fever (major -polyarthritis,minor :- ESR and Fever) and started him with aspirin 25 mg/kg/dose qid. But as the days passed his temperature has not settled yet but his arthritis has settled.We have stopped his aspirin as the arthritis have improved and he can walk now but his temperature still has not settled.his temp spikes from 37 to 40 degress and he almost always has 3-4 spikes per day. today is day 9 of his admission and day 14 of fever with arthritis,hsi fever is still not settled.We have chnaged his antibiotic from C peniciilin to IV Ceftriaxone. What are the differential diagnosis tp consider here?
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Answer |
A differentail diagnosis of systemic onset JRA, macrophage activation syndrome and autoimmune disorder should be considered. Since the child had fever along with arthritis, one would suspect acute rheumatic fever lower on the list as the fever usually precedes the arthritis and is not along with the arthritis. ONe may need to monitor the fever, ESR and CRP to decide whether steroids are necessary and if persistent even disease modifying agents may be required.
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