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I have thoroughly think about your query and tried to co-relate your symptoms with possible pathology may be there. No doubt at present strep test
is negative but we should rule out previous such infections and their sequllae, in this connection severe pain
in ankle may be rheumatic. Therefore you should do-
1- ASO titre.
2- Thorough cardiac examination.
3- C.T.Scan of para nasal sinuses
4- Culture and sensitivity of throat swab.
Thorough examination and clinical co-relation with inferences of above investigations will disclose the diagnosis, that may be accordingly manage.