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Suggest Treatment For Intermittent Fever, Sore Throat, Fatigue And Rashes On The Knees

Posted on Sat, 27 Aug 2016

Question: Eleven year old boy with intermittent fevers (101.2 to 103 degrees), sore throat with or w/o pustules first 2 days, abd pain, fatigue, with fever comes petechial rash from the knees to ankles. Lasts 7 days at least, was coming every 2 - 3 weeks now much more often. All labs are neg. Neg abd ultrasound, neg abd MRI. Has never had any immunizations. Lyme's was neg. Not been tested beyond usual Lyme's testing. Regularly backpacks and hikes. Next stop is Oncology consult. Between bouts he feels good, energy comes back and is his usual wonderful little self. We need help!!!

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
Need images and some more information

Detailed Answer:
Hi.... I need more information. Please get back to me with answers to my questions so that I can guide you better.

1. Has a rapid antigen test or throat swab culture been done during the episodes?

2. Does he have any significant weight loss in the past 3 months?

3. How is his appetite?

4. Are there any bone pains or joint swelling or small joint swelling of the fingers?

5. Is the rash which you are quoting itchi or is it possible for touch?

6. Do you have any images of the rash which you can upload, so that it will be more clear to me?

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (2 hours later)

Thank you. Throat swabs are always neg for strep, should something else be tested for? No real wt loss, but appetite does decrease. C/o left hip pain, but no arthritis or changes in MRI. The rash does not itch and it can be touched without pain. It goes away when the fever disappears. There hasn't been any noticeable joint swelling or pain except the left hip as above. No pictures of the rash right now that I know of. Rash is described as tiny pin prick size red flat rash.

Answered by Dr. Sumanth Amperayani (7 minutes later)

Brief Answer:
Possibilities on fever with rash

Detailed Answer:
Hi.....thank you for the history points.

My suggestions -

1. Recurrent viral illness with exanthema
2. Recurrent HSP or Henoch Schonlein Purpura
3. Connective tissue disorder.

If I were your pediatrician I would further do -

CBC, ANA, CRP, ESR, Serum IgA

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (21 minutes later)

Would treating the fever with antipyretics give u any information if the fever does or doesn't respond? Could we be getting negative urine now but occult blood or protein sporatically?

Answered by Dr. Sumanth Amperayani (2 hours later)

Brief Answer:
Suggestions on fever with rash

Detailed Answer:
Hi....coming to your queries....I will explain how a viral illness works....that will give you more confidence on if it is a viral illness.

Fever of few days without any localizing signs could as well a viral illness. Usually rather than fever, what is more important is the activity of the child, in between 2 fever episodes on the same day. If the kid is active and playing around when there is no fever, it is probably viral illness and it doesn't require antibiotics at all. Once viral fever comes it will there for 4-7 days. So do not worry about duration if the kid is active.

Occasional blood and protein in urine again is suggestive of either viral or a connective tissue disorder... This is why I suggested ANA.

Hives....may again point out towards toxic urticaria which could be viral related.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link.
Once the page opens there will be an option below my image as – ASK ME A QUESTION – click on it.

Please find the link below -

www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Regards - Dr. Sumanth

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar