Fever with Migratory Poly-arthritis
12 yr old boy was brought by parents to the OPD with the c/c fever on & off and joint pains since 2 months.
Mother tells 'my child is 12yr old. He is always active, his school performance is good.. He was admitted in hostel 2yrs back. On 25th of December 2018, we received a call from hostel that our boy is having cold and fever for which we brought him home. We took him to hospital and it was recorded as high grade fever a/w chills, no rigors and the fever got subsided with medication for about 3 days. And as he was back to normal we sent him to hostel.
He returned home on 14th of January 2019 for vacation, and I noticed that my son is limping and something is wrong with his left leg. On asking he denied and said it was all okay.. he again developed high grade fever on 18th of January with pain and swelling in the left ankle joint and was unable to walk for which we took him to govt.hospital where he was given calcium supplementation. After that he felt better and we sent him back to school on 24th of January.
4days later he fell down while playing and was unable to walk from then. So we consulted orthopaedic doctor where they advised X-rays and he was managed by POP & Traction for about 4 days. He was allowed to walk on 5th day. But he could not walk properly and during all this period he developed fever intermittently. he also had tremors in hands during episodes of fever.
After 1 week not satisfied by his outcome and on suggestion from neighbors we took our child to another orthopaedic doctor where he was again supplemented with calcium. After a week he developed swelling and pain in the right knee and right ankle along with restriction of movements. So we took him to higher center where again he was given calcium supplementation and they also done mantoux which was negative.
After 15 days he also developed pain,swelling and restriction of movements in the right elbow. Now pain and swelling decreased in the right knee and right ankle joint but are persisting in left ankle joint and right elbow joint along with restriction of movements. Boy denied any history of sore throat. Mother is telling that he lost around 10kg in the span of 3 months. No h/o rash during this period. No h/o chest pain. No restriction of movements of other small and large joints.
Past history: no h/o chronic joint pains or swelling
Family history: nil significant
Birth history: normal
Immunization history: immunized till date, BCG scar +
Developmental history: attained mile stones normally as per age and peer group
Diet history: calorie deficiency:450kcal
On examination,
Child is active, afebrile.
Moderately built and nourished
Vitals
Temp: 98.6°F
Pulse: 112bpm
RR:18cpm
Swelling in the right elbow and left ankle joint are seen.
Tenderness is elicited in right elbow, left knee, and right ankle joint.
Boy is limping
No skin rashes
Systemic examination
CVS: S1,S2 heard, No murmurs. No cardiac enlargement
RS: B/L NVBS heard, lungs are clear on both sides.
GIT: soft, non tender no organomegaly.
CNS: NFND
PROVISIONAL DIAGNOSIS:
?RHEUMATIC FEVER
?POST VIRAL-ARTHRALGIA
?JUVENILE RHEUMATOID ARTHRITIS
throat swab for C/S: normal oro-pharyngeal flora are grown
Mother tells 'my child is 12yr old. He is always active, his school performance is good.. He was admitted in hostel 2yrs back. On 25th of December 2018, we received a call from hostel that our boy is having cold and fever for which we brought him home. We took him to hospital and it was recorded as high grade fever a/w chills, no rigors and the fever got subsided with medication for about 3 days. And as he was back to normal we sent him to hostel.
He returned home on 14th of January 2019 for vacation, and I noticed that my son is limping and something is wrong with his left leg. On asking he denied and said it was all okay.. he again developed high grade fever on 18th of January with pain and swelling in the left ankle joint and was unable to walk for which we took him to govt.hospital where he was given calcium supplementation. After that he felt better and we sent him back to school on 24th of January.
4days later he fell down while playing and was unable to walk from then. So we consulted orthopaedic doctor where they advised X-rays and he was managed by POP & Traction for about 4 days. He was allowed to walk on 5th day. But he could not walk properly and during all this period he developed fever intermittently. he also had tremors in hands during episodes of fever.
After 1 week not satisfied by his outcome and on suggestion from neighbors we took our child to another orthopaedic doctor where he was again supplemented with calcium. After a week he developed swelling and pain in the right knee and right ankle along with restriction of movements. So we took him to higher center where again he was given calcium supplementation and they also done mantoux which was negative.
After 15 days he also developed pain,swelling and restriction of movements in the right elbow. Now pain and swelling decreased in the right knee and right ankle joint but are persisting in left ankle joint and right elbow joint along with restriction of movements. Boy denied any history of sore throat. Mother is telling that he lost around 10kg in the span of 3 months. No h/o rash during this period. No h/o chest pain. No restriction of movements of other small and large joints.
Past history: no h/o chronic joint pains or swelling
Family history: nil significant
Birth history: normal
Immunization history: immunized till date, BCG scar +
Developmental history: attained mile stones normally as per age and peer group
Diet history: calorie deficiency:450kcal
On examination,
Child is active, afebrile.
Moderately built and nourished
Vitals
Temp: 98.6°F
Pulse: 112bpm
RR:18cpm
Swelling in the right elbow and left ankle joint are seen.
Tenderness is elicited in right elbow, left knee, and right ankle joint.
Boy is limping
No skin rashes
Systemic examination
CVS: S1,S2 heard, No murmurs. No cardiac enlargement
RS: B/L NVBS heard, lungs are clear on both sides.
GIT: soft, non tender no organomegaly.
CNS: NFND
PROVISIONAL DIAGNOSIS:
?RHEUMATIC FEVER
?POST VIRAL-ARTHRALGIA
?JUVENILE RHEUMATOID ARTHRITIS
throat swab for C/S: normal oro-pharyngeal flora are grown
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All the below investigations were done on 11/3/19
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