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Case: 15 year old girl with difficulty of walking with aching joints | |
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A 15 year old girl has a 10 day history of mild fever (37.7 to 37.8 C; 100 to 101 F). She has difficulty of walking with aching joints. She has moderate pain at the shoulders, wrists, and hips. These pain are on both sides, intermittent, and not felt at other joints.. There is also mild cervical spine pain and elbow pain. She has also mild runny nose. She has no sore throat, cough, abdominal pain, diarrhea, morning stiffness, vaginal discharge, tick bites, or rashes. The only medication she has taken was acetaminophen and ibupropen. She did not travel out of the state. There was no family history of any collagen vascular diseases. On physical examination she has a temperature of 102 F (38.9 C), pulse of 88/min, respiration of 20/min, and blood pressure of 114/66 mm Hg. She was not in any acute distress but with exquisite pain at the shoulders, wrists, and hip joint when these are manipulated. Her range of motion is limited. Flexion on her elbow causes slight pain. The painful joints were not red or swollen. Her skin and the rest of the physical examination were normal. Her blood tests including CBC, ESR, Creatine Kinase, and Mono spot were all Rapid Strep test was normal as well as the urinalysis. The CRP was 6.2 mg/L which was elevated. An ECG was done and was interpreted to be normal too. Her throat culture showed heavy growth of nongroup A beta-hemolytic Streptococcus on selective agar plate. She was treated with oral penicillin, 500 mg BID for 10 days. This teenager had a Poststreptococcal reactive arthritis caused by nongroup A Streptococcus. After the penicillin was started her skin peeled which is characteristic of strep infections.
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