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Question |
8 year old boy with 2 episodes of lt knee monoarthritis accompanying exudative tonsilitis in a span of 3 months.Fever settled in 7 days with a course of IV cefuroxime and ibuprofen. The monoarthritis resolved in 4 to 5 days.ESR increased from 70mm on admission to 90mm to 105mm after a week.CBC showed microcytic hypochromic anemia with normal WBC and platelets.Monospot TORCH ASOT ANA and Rheumatoid factor were negative. Xray lt Knee with soft tissue swelling but normal joint spaces.No L.nodes,rash orhepatosplenomegaly. NOTE :This boy is the sibling with chronic polyarticular JRA on treatment.
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Answer |
Since it is monoarticular and the child had simultaneous tonsilittis, one would have to rule out septic arthritis. Also it could be reactive arthritis. If it persists for more than 6 months, rule out monoarticular JIA. Finally rarely, leukemia can present as this.
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