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I am curious how some of you would handle this case.
 
A 3 yo presents with complaint of fever for 6 days.  Fever maximum about 102.5
each day on ibuprofen and acetominophen.  Mother states child has had joint
aches in the knees and ankles for the last 3-4 weeks.  She has never had any
other joint findings.  She has also had clear rhinnorhea for the last 7-10
days.  She has had a mild  occasional nonproductive cough but no respiratory
distress.  She denies any nausea, vomiting, diarrhea, rash, headache, ear
pain, strange behavior, urinary symptoms, or vaginal discharge.  She had some
vague complaint of general abdominal discomfort a day or two ago but none
currently.  Child is eating, drinking and voiding normally.  Her past medical
history is significant for SVT and ECMO after birth for an unknown reason.
Family history is significant for lyme disease only.
Her vital signs are normal with the possible exception that her temperature is
99.5.  Oxygen saturation was 96% on RA.
 
Physical Exam:
Well hydrated, well developed child in no acute distress.  Sitting on bed with
mother.  She was somewhat irritable but easily consolled.
PERRL, EOMI, No conjunctival findings.
Normal ear drums and canals
Normal nasopharynx
Normal oropharynx
No meningeal findings.  6-7 <1cm tender mobile anterior cervical nodes.
Lungs normal
Heart normal
Abdomen entirely benign
Extremities- Normal- specifically no rash, fusiform swelling, skin peeling,
edema, joint findings.  Pulses intact throughout.
 
What work up would you do if any?
What diagnosis would you give?
What treatment would you give if any?
 
Thanks for your time,
Randy Cordle MD
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Lehigh Valley Hospital
 
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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html