Child presenting with fever, rash, and joint pain

MBBS
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An 8-year-old girl is brought to the clinic with a 4-day history of high fever and a red rash all over her body. She also complains of joint pain affecting both knees and wrists. The joints are swollen and tender. Her parents report that she seems more tired than usual and has decreased appetite. There is no history of recent travel or known infectious contacts.

What can be differential diagnosis

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  1. Still disease
  • Daily high spiking fever
  • salmon-pink rash
  • Arthritis
  • Fatigue
  • Lymphadenopathy, hepatosplenomegaly
  • high ESR and CRP
  • Negative ANA and RF

2.Rheumatic Fever

  • Migratory arthritis
  • carditis
  • subcutaneous nodules
  • erythema marginatum
  • chorea
  • BUT it can be less likely since the Strep. culture should be positive
  1. Kwasaki Disease
  • Fever ≥5 days
  • Rash
  • strawberry tongue
  • Conjunctivitis
  • edema
  • lymphadenopathy
  • and later stage of arthritis
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Based on the symptoms, possible differential diagnoses for the 8-year-old girl include:

  1. Juvenile Idiopathic Arthritis (JIA)
  2. Viral infections (e.g., parvovirus B19, rubella)
  3. Kawasaki disease
  4. Systemic lupus erythematosus (SLE)
  5. Acute rheumatic fever
  6. Lyme disease (less likely without tick exposure history)

Further evaluation, including laboratory tests and physical examination, would be necessary to narrow down the diagnosis.

A pediatrician or rheumatologist should be consulted for a thorough assessment.

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