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  #1  
Old 08-03-2011
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Heart Fever + Petechiae + Murmur + Fatigue + Splenomegaly!

A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis?

a. Rheumatic fever
b. Kawasaki disease
c. Scarlet fever
d. Endocarditis
e. Tuberculosis
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Old 08-03-2011
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a. rheumatic fever
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  #3  
Old 08-03-2011
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I'm between Kawasaki and Endocarditis, but more prone to Kawasaki...b-se of age and disease progression.
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endocarditis
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  #5  
Old 08-03-2011
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Endocarditis
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  #6  
Old 08-03-2011
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Endocarditis!

Kawasaki disease = youŽll need high-grade fever, lymph nodes, classic mucosa/skin manifestation and if you have a murmur...this is due to coronary vasculitis = myocardial infarction = heart failure (MI)
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Old 08-03-2011
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Endocarditis
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Old 08-03-2011
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endocarditis
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  #9  
Old 08-03-2011
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A.rheumatic fever
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  #10  
Old 08-03-2011
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a heart murmur, petechiae, and mild splenomegaly show endocarditis
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Old 08-03-2011
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Endocarditis.

Kawasaki is generally acute onset, in children less than 4 years of age, with typical skin rash and lymphadenopathy. coronary involvement is there which may be cause of death. does not fit here.

Why not rheumatic fever, when endocarditis is a complication of rheumatic fever?
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  #12  
Old 08-03-2011
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b). Kawasaki disease--
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  #13  
Old 08-03-2011
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Quote:
Originally Posted by bebix View Post
Endocarditis!

Kawasaki disease = youŽll need high-grade fever, lymph nodes, classic mucosa/skin manifestation and if you have a murmur...this is due to coronary vasculitis = myocardial infarction = heart failure (MI)
there is no H/O of CHD or any recent dental procedures or instrumentation and this small kid would not be an IV drug abuser + you wont get myalgias and headaches in endocarditis.. so why do you suspect BE?
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Old 08-03-2011
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Quote:
Originally Posted by drnirajmavani View Post
there is no H/O of CHD or any recent dental procedures or instrumentation and this small kid would not be an IV drug abuser + you wont get myalgias and headaches in endocarditis.. so why do you suspect BE?
@drnirajmavani...

"low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly"

endorcarditis vs...........Rheumatic fever?

petechiae, and mild splenomegaly...I tend to think that endocarditis is the closest option.
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Old 08-03-2011
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Quote:
Originally Posted by bebix View Post
@drnirajmavani...

"low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly"

endorcarditis vs...........Rheumatic fever?

petechiae, and mild splenomegaly...I tend to think that endocarditis is the closest option.
thanx...my bad...got to revise my vasculitis stuff again...LNopathy, nd strawberry tongur , wid conjunctival nd mucosal edema was jst erased frm my memory...
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Old 08-03-2011
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Quote:
Originally Posted by drnirajmavani View Post
there is no H/O of CHD or any recent dental procedures or instrumentation and this small kid would not be an IV drug abuser + you wont get myalgias and headaches in endocarditis.. so why do you suspect BE?
even i gt it wrong initially, but yes its endocarditis
if u dont get any clue...think its a new onset murmur, new onset murmur is endocarditis
i got confused by TB ----> rheumatic fever..should have read it more properly...
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Old 08-03-2011
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Quote:
Originally Posted by bebix View Post
@drnirajmavani...

"low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly"

endorcarditis vs...........Rheumatic fever?

petechiae, and mild splenomegaly...I tend to think that endocarditis is the closest option.

the question was posted in other forum as well...it is endocarditis, slow and subtle, but endocarditis.
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Old 08-04-2011
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so if we use the john's criteria for making the diagnosis, it can be rhumatic fever... cuz 2 from minor symptoms and 1 from major..
feveer and myalgia from minor and heart problem from major symptom makes it more like rhumatic!
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Old 08-04-2011
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B.kawasaki disease...
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  #20  
Old 08-04-2011
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endocarditis
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  #21  
Old 08-04-2011
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Post A

a. Rheumatic fever
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  #22  
Old 09-12-2012
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I disagree ....

Endocarditis
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Old 09-12-2012
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Quote:
Originally Posted by usmleman2020 View Post
A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis?

a. Rheumatic fever
b. Kawasaki disease
c. Scarlet fever
d. Endocarditis
e. Tuberculosis
so wats d correct answer???
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  #24  
Old 09-12-2012
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Quote:
Originally Posted by drajayjain View Post
Endocarditis.

Kawasaki is generally acute onset, in children less than 4 years of age, with typical skin rash and lymphadenopathy. coronary involvement is there which may be cause of death. does not fit here.

Why not rheumatic fever, when endocarditis is a complication of rheumatic fever?
Remember, that Rheumatic fever does not have bacterial vegetations on valves hence cant' embolize and cause petechei; bacterial endocarditis on the other hand has plenty of bacteria growing on the valves which can embolize and cause, petechei, janeway lesions, osler nodes, and even stroke
look at the images in webpath for the valvular pathologies so you see what they look like (it helps) just in case they throw you a pic on the exam
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Old 09-13-2012
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a. Rheumatic fever- prior GAS pharingitis>>> poly arthritis, carditis, subcut nodule, chorea, eruthema nodosum spleenomegaly and petechia unlikely

b. Kawasaki disease - 5yr olds, strawberry tongue, cervical lymphadenopathy, desqaumation of palms and sole, coronary artery aneurism

c. Scarlet fever - streprtococcal high grade fever and rashes, strawberry tingue and tonsillar exudates

d. Endocarditis- High grade fever+cardiac murmur, petechiae, oslers nodes, janeway lesions, spleeno megaly, roth spots etc

e. Tuberculosis- look out for nationality night sweats, wt loss, productive cough
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