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What causes lymph node swelling in the leg along with persistent fever?

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Posted on Wed, 16 May 2018
Question: 7 y/o female. Sick for 14 days now. (started with fever/vomiting), has included stiff neck/headaches from time to time. Fevers come back at night. Vomiting has stopped 9 days ago. Still getting fevers (especially if more physical exercise). Blood tests looked good. Negative for strep, flu, and lymes. Started treatment for lymes 3 days ago. Now notice a swollen left leg lymph node. Seems fine most of the day, little low on energy, but fine. Heading into weekend, have not heard back regarding mono test.
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Answered by Dr. Sumanth Amperayani (2 hours later)
Brief Answer:
The other possibilities could be inflammation or gram negative bugs

Detailed Answer:
Hi....I understand your concern.

I have gone through the history points you have provided.

I put forth these possibilities which you can discuss with your kid's pediatrician.

1. Brucellosis.

2. Enteric fever.

3. Non infective inflammation like auto immune phenomenon.

4. Prolonged viral illness.

5. Lymphoreticular neoplasm.

Can you please upload the reports of the tests which you have so far, so that I can go through them and get back to you.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumanth Amperayani (12 minutes later)
Thank you, I added the copies of the recent blood work. Hopefully that helps a little.
Regards, XXXXXXX
doctor
Answered by Dr. Sumanth Amperayani (29 minutes later)
Brief Answer:
Looks like a prolonged viral illness

Detailed Answer:
Hi.... I have gone through the investigation reports which you have uploaded. These investigations are pointing out towards a prolonged viral illness and not any serious medical disorder.

I have a few questions for you -

1. Before starting the antibiotic has any blood culture been performed?

2. Have you been ordered to get a urine routine and urine culture done?

3. As it is more than 7 days of fever now and running into second week end, I would like to know if any tube method of widal test has been done or not?

4. How is the activity of the kid when there is no fever?

5. How is the appetite of the kid?

6. Is there any yellowish discoloration of eyes or urine or pale coloured stools?

7. Is the kid having any rash over the body or joint pains at the fingers or large weight bearing joints of the body?

Please get back to me with answers so that I can guide you better.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (56 minutes later)
1. Before starting the antibiotic has any blood culture been performed? The antibiotic (Amoxicillin 3x daily) started on Tuesday 12/12 following the bloodwork ran on 12/11. I included the 6 photos of bloodwork, did you receive these?

2. Have you been ordered to get a urine routine and urine culture done? Urine was taken in one of the first appointments, approximately 10-12 days ago and all looked good.

3. As it is more than 7 days of fever now and running into second week end, I would like to know if any tube method of widal test has been done or not? I am unsure of this. I can research this and try to find out if this was done. I hadn't heard of this, but I will look.

4. How is the activity of the kid when there is no fever? Activity is lower than normal. She seems to be fine when working towards an event that she really wants to attend and then crashes afterwards (fever really spikes following, seems to relapse).

5. How is the appetite of the kid? Has definitely gotten better, but still not the same as it usually is.

6. Is there any yellowish discoloration of eyes or urine or pale coloured stools? No.

7. Is the kid having any rash over the body or joint pains at the fingers or large weight bearing joints of the body? Most of the pain (woke up crying last night with fever of 102.1 and pain in left shoulder blade) is focused around neck, headache (not often) and back pain. The majority of the pain is in the nighttime and seems much better during the day. She has relayed to us that her legs feel weak at times and tends to favor a side in her walk (this might just be her being dramatic).

There actually has been a lot of complaining about pain in some major joints...hips, shoulders etc. Lots of muscle pain in other areas too.
And yes her appetite has been over all reduced. She’s lost seven pounds in 15 days.
doctor
Answered by Dr. Sumanth Amperayani (1 hour later)
Brief Answer:
Suggestions and possibilites on prolonged fever

Detailed Answer:
Hi...Thank you for the information.

1. Blood culture is not mentioned anywhere in the reports and hence I inquired about it. Please ask your pediatrician and get back regarding this. Same is the case with WIDAL test also.

2. With all the above information i have received and with CRP being just above the normal with so much systemic symptoms and fever of almost 13 days - I would put forth these possibilities and tests to be performed.

Possibilities -
1. Viral illness with reactive arthritis like Chikungunya fever.
2. Auto immune disorder (evolving) like - SLE.
3. Rare but to be considered due to body pains and weight loss - Lymphoreticular neoplasm. But can be considered if fever is still persisting even a week later.

Investigations -

1. ESR.
2. ANA and if this is positive - to do anti ds DNA.
3. LDH
4. Ultrasound abdomen

Hope this helps.

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



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

Pediatrician, Pulmonology

Practicing since :2003

Answered : 8342 Questions

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What causes lymph node swelling in the leg along with persistent fever?

Brief Answer: The other possibilities could be inflammation or gram negative bugs Detailed Answer: Hi....I understand your concern. I have gone through the history points you have provided. I put forth these possibilities which you can discuss with your kid's pediatrician. 1. Brucellosis. 2. Enteric fever. 3. Non infective inflammation like auto immune phenomenon. 4. Prolonged viral illness. 5. Lymphoreticular neoplasm. Can you please upload the reports of the tests which you have so far, so that I can go through them and get back to you. Regards - Dr. Sumanth