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What Causes Severe Joints Pain In A 7 Year Old Child?
Question: Dear Doctor,
My daughter 7 years old is on ATT since 19th march 2016. She had fever and knee joint pain on right side for over one and half month. Mantous was positive and CT & X ray showed Hiler Lymph adenopathy. Bronchoscopy, GL, Bone marrow & CSF was done but no AFB found. Malignancy also ruled out. Based on mantoux & CT, ATT was atarted on 19th march.
STill fever is persisting though it was better for a few days after starting ATT. The fever used to be low grade rising high at times when we had to give her Paracetamol. When she has fever she also has pains on joints, sometimes nee joints, sometime shoulder joints and sometimes on sole also. This pain is always there when she has fever. On 29th april morning , she had high fever (101 + deg F) and she complained of acute pain in left knee and right shoulder joint. The fever didnt go fully even after giving PCM 250. By the evening the fever was gone completely and so was the pain. She was very very active the next day. Again on 1st she had some fever and on 2nd may she had temperature around 100+ in the afternoon and we had to give her PCM. Today till now she is okay.
6 days back she had conjuntivities in her eye.
Doctor, I just wanted to know how ling the fever persists after starting ATT?? What is the cause of Joint pains?? Also sometimes during fever she developes nodes and red rashes in her sole which is very painful (Photographs attached)
Also enclosed are the test results for various investigations.
Please give your opinions... really worried we are..
XXXXX
My daughter 7 years old is on ATT since 19th march 2016. She had fever and knee joint pain on right side for over one and half month. Mantous was positive and CT & X ray showed Hiler Lymph adenopathy. Bronchoscopy, GL, Bone marrow & CSF was done but no AFB found. Malignancy also ruled out. Based on mantoux & CT, ATT was atarted on 19th march.
STill fever is persisting though it was better for a few days after starting ATT. The fever used to be low grade rising high at times when we had to give her Paracetamol. When she has fever she also has pains on joints, sometimes nee joints, sometime shoulder joints and sometimes on sole also. This pain is always there when she has fever. On 29th april morning , she had high fever (101 + deg F) and she complained of acute pain in left knee and right shoulder joint. The fever didnt go fully even after giving PCM 250. By the evening the fever was gone completely and so was the pain. She was very very active the next day. Again on 1st she had some fever and on 2nd may she had temperature around 100+ in the afternoon and we had to give her PCM. Today till now she is okay.
6 days back she had conjuntivities in her eye.
Doctor, I just wanted to know how ling the fever persists after starting ATT?? What is the cause of Joint pains?? Also sometimes during fever she developes nodes and red rashes in her sole which is very painful (Photographs attached)
Also enclosed are the test results for various investigations.
Please give your opinions... really worried we are..
XXXXX
Brief Answer:
Possibilities of this prolonged illness discussed
Detailed Answer:
Hi...Greetings from XXXXXXX and XXXXXXX Kamakoti CHILDS Trust Hospital.
I understand your concern. The doctors at CMC Vellore have done extremely well in working up for arriving at the diagnosis of your child.
The possibilities -
1. TB - is my first consideration and possibility too. Usually fever will take 7-10 days to settle after starting appropriate anti tubercular therapy. The necrotic areas and the collapse of the lung are suggestive of this. Though all other tests except Mantoux are negative - In XXXXXXX scenario - this is still a possibility.
2. Connective Tissue disorder or Autoimmune disease - The images you have uploaded along with the joint pains which are persisting along with fever are very much suggestive of this problem. But they have worked up for this and ANA is negative. But High ESR and high CRP and high platelet counts are suggestive of this.
I would like to consider the possibility of Systemic onset Juvenile Idiopathic arthritis or SOJIA in short.
Can you please discuss with your doctor there and get back to me please.
Regards - Dr. Sumanth
Possibilities of this prolonged illness discussed
Detailed Answer:
Hi...Greetings from XXXXXXX and XXXXXXX Kamakoti CHILDS Trust Hospital.
I understand your concern. The doctors at CMC Vellore have done extremely well in working up for arriving at the diagnosis of your child.
The possibilities -
1. TB - is my first consideration and possibility too. Usually fever will take 7-10 days to settle after starting appropriate anti tubercular therapy. The necrotic areas and the collapse of the lung are suggestive of this. Though all other tests except Mantoux are negative - In XXXXXXX scenario - this is still a possibility.
2. Connective Tissue disorder or Autoimmune disease - The images you have uploaded along with the joint pains which are persisting along with fever are very much suggestive of this problem. But they have worked up for this and ANA is negative. But High ESR and high CRP and high platelet counts are suggestive of this.
I would like to consider the possibility of Systemic onset Juvenile Idiopathic arthritis or SOJIA in short.
Can you please discuss with your doctor there and get back to me please.
Regards - Dr. Sumanth
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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