A Diagnostic Dilemma: Sometimes You ’ ll Never Know

Patient Presentation A 9-year-old male came to clinic with a 1 month history of painful joint swelling. One month ago he started having right ankle pain that was intermittent but consistent. One day ago his right wrist, right ankle and bilateral knees had some swelling but no erythema or warmth. He says that he has pain in them when he moves but not when he is resting and he denies any joint stiffness or gelling. He also had 1-2 days of multiple red skin lesions on his extremities and trunk, not overlying the affected joints. The skin lesions do not come and go and do not itch. They are mainly discrete circular lesions with no central clearing and did not change since they noticed them. The father and patient deny any recent infections but his sibling had a strep throat a few weeks ago. They had used ibuprofen and diphenhydramine orally once each without any symptom changes. They denied any contact with animals, ticks bites or non-city water supply. They deny any travel or contact with others from oversees, military personnel or institutionalized persons. They denied any history of trauma, no medication or other drug use and the child was not under unusual stress. In the review of systems he denies any fever, chills, no eye changes, muscle aches, no pain in general and sore throat or ear pain specifically, and weight changes or clothing fitting differently. He has no problems with breathing or swallowing, problems on exertion, heart palpitations, syncope or any gastrointesti...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news

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Source: Frontiers in Physiology - Category: Physiology Source Type: research
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