A boy with fever and arthralgiaBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1347 (Published 29 March 2017) Cite this as: BMJ 2017;356:j1347
- Federico Poropat, paediatrician,
- Serena Pastore, paediatrician,
- Valentina Gesuete, paediatrician,
- Egidio Barbi,, paediatrician
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Correspondence to S Pastore
An eight year old boy was admitted to the emergency department with a seven day history of medium grade fever with mild headache, sore throat, arthralgia in his wrists, and pain in the soles of his feet. He had been evaluated on the second day by his general practitioner, who had prescribed amoxicillin, but this treatment had been ineffective. Physical examination on admission showed the boy to be well, with body temperature 37.4°C, mild pharyngeal erythema with a moderate enlargement of cervical lymph nodes, heart rate 107 beats per minute without murmurs, clear breath sounds, no liver or spleen enlargement, no skin rash, and no arthritis.
Blood tests showed white blood cell count 8.66 ×109/L (reference range: 4-11 ×109/L) with 60% neutrophils, haemoglobin 12.5 g/dL (reference range: 12-16 g/dL), platelet count 374. ×109/L (reference range: 15-40 ×109/L), erythrocyte sedimentation rate 85 mm/h (normal value <20 mm/h), C reactive protein 11.5 mg/dl (normal value <0.5 mg/dL), and anti-streptolysin titre 854 UI/ml (normal value <100 UI/mL).
A two dimensional echocardiogram (fig 1, fig 2⇓) showed a regurgitant jet, which was minimal, inconsistent, and visible only in a single projection. The regurgitation is a not uncommon finding in the paediatric population.12