Is Knee Joint Pain A Symptom Of Rheumatic Fever?
Question: I have a 2.5yr old who has had consistent low-grade fever (99-101) multiple times a week, with little or no symptoms for 3-4 months. During this time he also had strep on his bottom and was treated w antibiotics. I assumed having strep for a long time now finally diagnosed would eliminate the fevers. They continued. He was then given a steroid after he was struggling with coughing and 103.5 range fever spike for 6 or 7 days. They prescribed Amoxicillin and diagnosed double ear infection. We finished up 10 days later and 4 days later he began complaining of his ears again. They said left ear full blown infection and fluid in right. They changed him to Augmentin. We are 5 days into this and he spikes a 102.5 rectally. I don't normally get concerned before 104, but this has been going on for months. They have not ran CBC bc they want his infection to be gone so they have a clear baseline. But meanwhile....he gets worse. This is the first time he's complained about his knee hurting multiple times. I'm concerned.
Brief Answer:
It could be Rheumatic fever - suggestions on this
Detailed Answer:
Hi....as you have mentioned an important symptom of knee joint hurting.... Along with a background of streptococcal infection, my first clinical suspicion would be to rule out Rheumatic fever.
I would suggest doing the following -
Complete blood picture
ESR
CRP
ECG
Echocardiogram
ASO titre
Based on these results we can proceed further.
Regards - Dr. Sumanth
It could be Rheumatic fever - suggestions on this
Detailed Answer:
Hi....as you have mentioned an important symptom of knee joint hurting.... Along with a background of streptococcal infection, my first clinical suspicion would be to rule out Rheumatic fever.
I would suggest doing the following -
Complete blood picture
ESR
CRP
ECG
Echocardiogram
ASO titre
Based on these results we can proceed further.
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Raju A.T
He had strep on his bottom/anus for a couple months. It would flare up then go away. We had no idea what was going on until it flared up and wouldn't go away. We thought it was something he was eating etc. even though this was of his bottom and not throat is RF still considered? This is only the first time he's been complaining of his knees. Additionally his occasional nanny did watch him a couple days then was diagnosed with mono. They do not share utensils. However his symptoms stemmed from long before her diagnosis. (Just trying to consider all possibilities)
Brief Answer:
Unlikely to be RF without sorethroat...but may be unnoticed
Detailed Answer:
Hi...I agree with you that RF is unlikely with skin infection... But sore throat might have gone unnoticed. Moreover RF is because of immunological phenomenon... So theoretically the possibility still exists. Moreover the kid has developed joint pains also. This is the reason why I am suggesting this possibility and investigations.
Once it is ruled out, we can be rest assured.
Regards - Dr. Sumanth
Unlikely to be RF without sorethroat...but may be unnoticed
Detailed Answer:
Hi...I agree with you that RF is unlikely with skin infection... But sore throat might have gone unnoticed. Moreover RF is because of immunological phenomenon... So theoretically the possibility still exists. Moreover the kid has developed joint pains also. This is the reason why I am suggesting this possibility and investigations.
Once it is ruled out, we can be rest assured.
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Raju A.T
He does point to his mouth and say "my mouth my mouth" but hard to tell. Glands aren't swollen and previous Pediatrician said that coughing with ear infection may be draining that is occurring. He is scheduled for testing tomorrow regardless of not having finished current round of antibiotics. He's been on antibiotics for strep, then just after that ears. Then stronger meds for ears (currently). I did not think much of the recurring low-grade and random spikes of higher fevers until it was brought up at dr visit 2 weeks ago. I assumed "he's a toddler" but due to the consistency they raised concern but held off on CBC due to Ear diagnosis.
Brief Answer:
Rule out Rheumatic fever - that is my suggestion - but age is also against it
Detailed Answer:
Hi... I am suggesting to rule RF because of the points I suggested above.
The other possibility is that -
1. Reactive arthritis.
2. Viral illness which might be causing this.
If possible please update me on the lab investigations so that I can assist you better.
Regards - Dr. Sumanth
Rule out Rheumatic fever - that is my suggestion - but age is also against it
Detailed Answer:
Hi... I am suggesting to rule RF because of the points I suggested above.
The other possibility is that -
1. Reactive arthritis.
2. Viral illness which might be causing this.
If possible please update me on the lab investigations so that I can assist you better.
Regards - Dr. Sumanth
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Above answer was peer-reviewed by :
Dr. Sonia Raina