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Why is my son experiencing pain in the arms and post auricular lymph node?

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General & Family Physician
Practicing since : 2004
Answered : 1773 Questions
My son 10 years old was having fever for about 30-35 days. Initially temperature was around 101-104. It will subside when given paracetamol for about 4-5 hours; then once again it will increase to 104. He tested negative for MP & Vidal. His blood & platelet count was normal during all the period.
He was given medicines in the following order:

1) Zenacin
2) Cephixime
3) Chloroquinine
4) Falcigo
5) Cephixime
6) Monocef (IV)
7) Ciproflaxin (IV)
8) Monocef (IV)
9) Cephixime.

In the mean time, he was tested positive for Montoux. But he was complaining of pain in the area of Montoux testing. Still slight pain is there.
Immediately he was started AKT (4 drug). His chest X-ray was normal; Brain CT was normal & Ultrasonography of abdomen was normal. His Liver & spleen is normal.

After 45 days, temperature automatically came down (below 100). He took AKT for about 20 days; then he was advised to stop continuing AKT. Now he is not under any medication. He is tested negative for hyperthyroidism, XXXXXXX was borderline (1.02) & DNA(ds) negative.

Finally the doctors told it may be due to Pyrexia of Unknown Origin (PUO) or may be even viral.

At present he is complaining of the following:

1) Pain in the elbow joints (only when folding)
2) Pain the wrists (only when folding)
3) Pain in the middle & index fingers (only when folding)
4) Pain behind the right ear - post auricular lymph node (no swelling & pain only if pressed)
5) Pulse rate of 100-110 continuously; even when asleep

I will be glad if you could tell me the exact reason why he had temperature and why he is having pains in hands & fingers and reason for pain in lymph node (post auricular) behind right ear
Posted Thu, 3 May 2012 in General Health
Answered by Dr. Chakravarthy Mazumdar 10 hours later
Hi Marshal,

These kind of cases are a real challenge to the doctor's clinical acumen.

Most of such cases would not get proper diagnosis and end up with a diagnosis of PUO or a viral etiology. So even in your son's case similar series would have happened. I can totally understand the agony of the parents of such children who do not get better.

A 104 degree temperature with no other symptoms relating to Pulmonary TB was not a proper line of treatment given to your child. Hence the doctor stopped it abruptly. This can lead to resistance for TB treatment.

Now let me answer your queries.
1) The pain at the small joints can be of these possibilities:

a) Recovery from viral illness such as Chickengunya can take much longer than expected ( 6 months )

b) His joint pains as described are in healing phase

c) Synovitis and Tenosynovitis is common after prolonged illness of 45 days.

d) I request to keep serial labs of CBC, ESR and CRP

2) A three- to four-week period of observation is prudent in patients with post auricular node and a benign clinical picture. If it is more than 1cm in size and even if other lymph nodes are involved, it should be investigated further.

Post auricular lymph node drains External pinna, Scalp and Meatus. Hence one should certainly look for scalp infections, wax before considering generalized infections. Otherwise any generalized infections like the viral infection can cause this.

3) If the ESR, CRP is persistently raised after 4 to 6 weeks, I also suggest to seek an opinion from Clinical Immunologist / Rheumatologist. I say if they can suspect Granulomatous & other inflammatory disorders.

To summarize, wait and watch for your son to get better. The regression of symptoms should ease your breath now. Increase his diet, variety of vegetables, fruits and nuts along with egg, milk fasten his recovery.

Hope this helps.

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