A 4-Year-Old Boy Is Brought to the Emergency Department for Evaluation

question 371

Multiple Choice

A 4-year-old boy is brought to the emergency department for evaluation of persistent fevers.  About 6 weeks ago, the patient developed rhinorrhea, cough, and body aches after returning from a family trip to Costa Rica.  Although the other symptoms resolved, he still has intermittent fevers and aches.  The fevers tend to spike in the evenings and are accompanied by a pink, nonpruritic rash.  Both features completely resolve by morning.  The patient has continued to attend preschool because he feels well during the day.  However, he has had a fever and rash every evening for the last 5 days.  The patient takes no medications.  Temperature is 39.1 C (102.4 F) .  He appears tired.  The oropharynx and bilateral tympanic membranes are normal.  Cardiac examination shows tachycardia without murmurs.  There are several pink macules at the waist and bilateral axillae.  The spleen is palpable 3 cm below the costal margin.  There is swelling of both knees and tenderness with deep palpation.  Laboratory results are as follows: Which of the following is the most likely diagnosis in this patient?

• A)Acute rheumatic fever
• B)Dengue virus infection
• C)Malaria
• D)Parvovirus B19 infection
• E)Systemic juvenile idiopathic arthritis
• F)Systemic lupus erythematosus

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Definitions:

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