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What Causes Rash On Back And Knees With Positive ANA Test?

Posted on Thu, 9 Apr 2015

Question: 14 year old male with positive ana and positive anti ssb. Stretch mark like rashes on back and knees, fatigue, kidney flank pain with nothing showing wrong, headaches. Mother with dermatomyositis. He is negative on anti dna, scl-70, ssa, and ra. Please let me know your guess and what further tests to explore.

Answered by Dr. Naval Mendiratta (24 minutes later)

Brief Answer:
? Connective Tissue Disease

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well firstly i would like to know why was ANA done. The sort of symptoms you have mentioned can be seen in a Teenager, they are known as Growing Pains.
I would like to ask you a few queries before recommending you further tests

1. Does he have any history of oral ulcers or dryness of the mouth?

2. ANy history of joint pains or joint swellings?

3. Any history of dryness in the eyes or redness in the eyes?

4. ANy history of rashes over the face or photosenstivity?

5. Any complaints of difficulty in getting up from Toilet seat/or climbing stairs/or combing hair?

6. Has the thyroid LEvels been checked?

ANA can be positive in children, but we need to look at the implications for it. Dermatomyositis does not have much a genetic transmission risk. So you need not worry about it.

Do let me know these queries. Would guide you further regarding the tests

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Naval Mendiratta (32 minutes later)

He has had complaints of kidney pain for months, rash on back, knees and buttocks, joint pain, fatigue, dizzy, enlarged neck glands and generally feeling unwell. Positive for ssb, ana positive abnormal, and previous chronic ebv. No dry mouth or sores. No thyroid test.

Answered by Dr. Naval Mendiratta (14 hours later)

Brief Answer:
? Is it connective tissue disease

Detailed Answer:
Good evening

Thanks for your reply

Well the sort of symptoms you are describing along with the ANA and SSB positivity can fit in with Juvenile Systemic Lupus Erythrematous.( Juvenile SLE). The rashes, Lymph node enlargement, joint pains and fatigue can go in with SLE. I am not sure if you have consulted your rheumatologist there yet, but you need to take an opinion for further management.

We need to investigate him further to see what other organs are involved. A routine urine examination, ESR along with liver function and renal functions tests need to be done. There is a possibility that it can just be a minor organ.

But yes, i would still prefer you take an opinion from a Rheumatologist as the examination part is needed to confirm the findings.

Do let me know for more queries

Would be happy to help you out

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Prasad