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IN NEED OF A DIAGNOSIS - 4yr Old wih fever for over 4 weeks
My soon to be 4 year old daughter has had daily fevers for 4 and a half weeks now. Temps vary from 99 to 103.5. On the onset of the disease she had rashes that would come and go and be more intense with fever (I would call them red not salmon), right now they are almost gone. She complaints about leg and feet pain which seemed to have gotten progressively worse - she has not walked properly for the past two weeks. SED rate and CRP are both very high. She is very anemic with iron levels dropping over the period. She was hospitalized for almost 3 weeks where she got treatment for Rocky Mountain Spotted Fever and Kawasaki disease which were both ruled out after treatment. Diskitis is out as well thru an MRI, bone marrow was normal.
Her pediatrician thinks she has some kind of Juvenile Arthritis but two Rheumatologists (one from Wake Forest the other from Duke) do not think that's what she has. In the meantime the fever keeps going and unless she takes ibuprofen she will just lay in bed moaning and complaining. Even with the medicine she still does not walk. We are ready for the disease to either go away to never come back (best case) or for a doctor to give us a diagnosis and a treatment that makes our little star better. I know this is all very generic but is there anyone in this community with clues to our puzzle?
We appreciate any suggestions at this point
Her pediatrician thinks she has some kind of Juvenile Arthritis but two Rheumatologists (one from Wake Forest the other from Duke) do not think that's what she has. In the meantime the fever keeps going and unless she takes ibuprofen she will just lay in bed moaning and complaining. Even with the medicine she still does not walk. We are ready for the disease to either go away to never come back (best case) or for a doctor to give us a diagnosis and a treatment that makes our little star better. I know this is all very generic but is there anyone in this community with clues to our puzzle?
We appreciate any suggestions at this point
We spent the day at UNC Chapel Hill with a lot of blood work but doctors (ID, Rheumatologist, and Diagnosis Specialist) gave us a diagnosis of Systemic Juvenile Rheumatoid Arthritis and we are starting treatment with steroids tonight. Doctors expect her to improve within 3 days. We are keeping our fingers crossed.
Thank you.
We have requested her pediatrician to test her for Lyme disease yesterday. Doctors at the hospital had dismissed our questions about lyme disease saying NC is not an area affected by the disease. Her pediatrician thought it was a good idea to test her since we just moved from Ohio less than six months ago.
We have requested her pediatrician to test her for Lyme disease yesterday. Doctors at the hospital had dismissed our questions about lyme disease saying NC is not an area affected by the disease. Her pediatrician thought it was a good idea to test her since we just moved from Ohio less than six months ago.
this sounds like lymes disease to me...ive been up all night...im very tired so heres an assortment of info on lymes disease... however the rash shown may vary and the clearing in between the center bullseye and the outer ring may be completely red... read this whole post it shows the varying symptoms
Stage 1 – Early localized infection
Common bullseye rash pattern associated with Lyme Disease.
Characteristic "bulls-eye"-like rash caused by Lyme disease.The classic sign of early local infection is a circular, outwardly expanding rash called erythema chronicum migrans (also erythema migrans or EM), which occurs at the site of the tick bite 3 to 32 days after being bitten. The rash is red, and may be warm, but is generally painless. Classically, the innermost portion remains dark red and becomes indurated; the outer edge remains red; and the portion in between clears – giving the appearance of a bullseye. However, the partial clearing is uncommon, and thus a true bullseye occurs in as few as 9% of cases.
Erythema migrans is thought to occur in about 80% of infected patients. Patients can also experience flu-like symptoms such as headache, muscle soreness, fever, and malaise.
Lyme disease can progress to later stages even in patients who do not develop a rash.
Stage 2 – Early disseminated infection
Within days to weeks after the onset of local infection, the borrelia bacteria may begin to spread through the bloodstream. Erythema chronicum migrans may develop at sites across the body that bear no relation to the original tick bite. Another skin condition, which is apparently absent in North American patients, is borrelial lymphocytoma, a purplish lump that develops on the ear lobe, nipple, or scrotum. Other discrete symptoms include migrating pain in muscles, joint, and tendons, and heart palpitations and dizziness caused by changes in heartbeat.
Acute neurological problems, which appear in 15% of untreated patients, encompasses a spectrum of disorders. One is facial or Bell's palsy, which is the loss of muscle tone on one or both sides of the face. Another common neurologic manifestation is meningitis, characterized by severe headaches, neck stiffness, and sensitivity to light. Radiculoneuritis causes shooting pains that may interfere with sleep and abnormal skin sensations. Mild encephalitis may lead to memory loss, sleep disturbances, or changes in mood or affect. In addition, simple altered mental status as the sole presenting symptom has been reported in early neuroborreliosis.
Stage 3 – Late persistent infection
Deer tick life cycleAfter several months, untreated or inadequately treated patients may go on to develop severe and chronic symptoms affecting many organs of the body including the brain, nerves, eyes, joints and heart. Myriad disabling symptoms can occur.
Chronic neurologic symptoms occur in up to 5% of untreated patients. A polyneuropathy manifested primarily as shooting pains, numbness, and tingling in the hands or feet may develop. A neurologic syndrome called Lyme encephalopathy is associated with subtle cognitive problems such as difficulties with concentration and short term memory. Such patients may also experience profound fatigue. Other problems such as depression and fibromyalgia are no more common in people who have been infected with Lyme than in the general population. Chronic encephalomyelitis, which may be progressive, may involve cognitive impairment, weakness in the legs, awkward gait, facial palsy, bladder problems, vertigo, and back pain. In rare cases, frank psychosis has been attributed to chronic Lyme disease effects, including mis-diagnoses of schizophrenia and bipolar disorder. Panic attack and anxiety can occur, also delusional behavior, including somatoform delusions, sometimes accompanied by a depersonalization or derealization syndrome similar to what was seen in the past in the prodromal or early stages of general paresis.
Lyme arthritis usually affects the knees. In a minority of patients arthritis can occur in other joints, including the ankles, elbows, wrist, hips, and shoulders. Pain is often mild or moderate, usually with swelling at the involved joint. Baker's cysts may form and rupture. In some cases joint erosion occurs.
Acrodermatitis chronica atrophicans (ACA) is a chronic skin disorder observed primarily in Europe. ACA begins as a reddish-blue patch of discolored skin, usually in sun-exposed regions of the upper or lower limbs. The lesion slowly atrophies, and the skin may become so thin that it resembles wrinkled cigarette paper.
if you have any questions feel free to ask...and please keep me posted
Stage 1 – Early localized infection
Common bullseye rash pattern associated with Lyme Disease.
Characteristic "bulls-eye"-like rash caused by Lyme disease.The classic sign of early local infection is a circular, outwardly expanding rash called erythema chronicum migrans (also erythema migrans or EM), which occurs at the site of the tick bite 3 to 32 days after being bitten. The rash is red, and may be warm, but is generally painless. Classically, the innermost portion remains dark red and becomes indurated; the outer edge remains red; and the portion in between clears – giving the appearance of a bullseye. However, the partial clearing is uncommon, and thus a true bullseye occurs in as few as 9% of cases.
Erythema migrans is thought to occur in about 80% of infected patients. Patients can also experience flu-like symptoms such as headache, muscle soreness, fever, and malaise.
Lyme disease can progress to later stages even in patients who do not develop a rash.
Stage 2 – Early disseminated infection
Within days to weeks after the onset of local infection, the borrelia bacteria may begin to spread through the bloodstream. Erythema chronicum migrans may develop at sites across the body that bear no relation to the original tick bite. Another skin condition, which is apparently absent in North American patients, is borrelial lymphocytoma, a purplish lump that develops on the ear lobe, nipple, or scrotum. Other discrete symptoms include migrating pain in muscles, joint, and tendons, and heart palpitations and dizziness caused by changes in heartbeat.
Acute neurological problems, which appear in 15% of untreated patients, encompasses a spectrum of disorders. One is facial or Bell's palsy, which is the loss of muscle tone on one or both sides of the face. Another common neurologic manifestation is meningitis, characterized by severe headaches, neck stiffness, and sensitivity to light. Radiculoneuritis causes shooting pains that may interfere with sleep and abnormal skin sensations. Mild encephalitis may lead to memory loss, sleep disturbances, or changes in mood or affect. In addition, simple altered mental status as the sole presenting symptom has been reported in early neuroborreliosis.
Stage 3 – Late persistent infection
Deer tick life cycleAfter several months, untreated or inadequately treated patients may go on to develop severe and chronic symptoms affecting many organs of the body including the brain, nerves, eyes, joints and heart. Myriad disabling symptoms can occur.
Chronic neurologic symptoms occur in up to 5% of untreated patients. A polyneuropathy manifested primarily as shooting pains, numbness, and tingling in the hands or feet may develop. A neurologic syndrome called Lyme encephalopathy is associated with subtle cognitive problems such as difficulties with concentration and short term memory. Such patients may also experience profound fatigue. Other problems such as depression and fibromyalgia are no more common in people who have been infected with Lyme than in the general population. Chronic encephalomyelitis, which may be progressive, may involve cognitive impairment, weakness in the legs, awkward gait, facial palsy, bladder problems, vertigo, and back pain. In rare cases, frank psychosis has been attributed to chronic Lyme disease effects, including mis-diagnoses of schizophrenia and bipolar disorder. Panic attack and anxiety can occur, also delusional behavior, including somatoform delusions, sometimes accompanied by a depersonalization or derealization syndrome similar to what was seen in the past in the prodromal or early stages of general paresis.
Lyme arthritis usually affects the knees. In a minority of patients arthritis can occur in other joints, including the ankles, elbows, wrist, hips, and shoulders. Pain is often mild or moderate, usually with swelling at the involved joint. Baker's cysts may form and rupture. In some cases joint erosion occurs.
Acrodermatitis chronica atrophicans (ACA) is a chronic skin disorder observed primarily in Europe. ACA begins as a reddish-blue patch of discolored skin, usually in sun-exposed regions of the upper or lower limbs. The lesion slowly atrophies, and the skin may become so thin that it resembles wrinkled cigarette paper.
if you have any questions feel free to ask...and please keep me posted
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