Case
recative arthritis

Age: 1145214
Sex: Female
Race: white

History
History of present illness:
a 14old girl with a history of two weeks of itching maculopapular rash in trunk and limbs with migratory polyarthritis at the small and large joints. labs finding at first:ASO333 * U/A:RBC6-7,wbc3-4,bacteria few,cast -,pr - * RF negative* CRP+ * ESR 40 * CBC normal * PLT NORmal * BUN & cr normal * ALT & AST normal.
labs after 1 week : ASO133* CRP - * RF - * U/A normal * ESR 36 * urine24hours: voulome 910cc, protein 593mgr * S/E normal * EKG Normal(include PR interval)* cardiac suffle - * .
after 1 week of onset of disease with use of prednislone 5mgr Bid rash very decreasd but migratory polyarthritis not changed. patient is not ill. fever - .


Medical History:
meningitis with mumps 7 years ago with no effects healed.

Past surgical history:
adenoidectomy & tonsilectomy 5 years ago

Allergies:
no

Medications:
Amp triamcinolone 40 mgr im stat.
tab prednisolone 5 mgr Bid .
syr hydroxyzine tds.

Family history:
no

Social history:
no


Physical Exam
General:
polyarthritis migratoy at fingers, knees, wrists,.
rash with prurities at trunk and limbs.


Temperature:
37.5 c

Heart rate:
87

Blood pressure:
100/75

Respiratory rate:
28

Head, ears, eyes, nose & throat:
normal

Neck:
transient pain.

Chest:
Auscultation of lungs & heart Normal

Cardiovascular:
NL

Abdomen:
rash maculopapular

GU:
NL

Rectal:
nl

Neurological:
nl

Skin:
rash with itching

Laboratories:
. labs finding at first:ASO333 * U/A:RBC6-7,wbc3-4,bacteria few,cast -,pr - * RF negative* CRP+ * ESR 40 * CBC normal * PLT NORmal * BUN & cr normal * ALT & AST normal.
labs after 1 week : ASO133* CRP - * RF - * U/A normal * ESR 36 * urine24hours: voulome 910cc, protein 593mgr * S/E normal * EKG Normal(include PR interval)* cardiac suffle - *

Radiology:
not finding

Plan of treatment:
Amp triamcinolone 40 mgr im stat.
tab prednisolone 5 mgr Bid .
syr hydroxyzine tds

Results of treatment:
rash was decreased but polyarthritis not changd.

Discussion:
DDx: JRA,Reactive,slE,ARF,viral,henoch-schoenline.




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1943je8/30/2007 - 4:41:21 PM
artritis reactiva


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