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  #1  
Old 02-04-2012
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Question Rash and Arthritis then heart failure then death!

12 year old female patient comes with complaints of dyspnea, erythematous rash.

O/E-- it is associated with painful joint swellings of the knee and hip joints
there is cardiac enlargement and signs of pulmonary edema.

patient develops intractable CHF and dies 2 days later.

which of the following did the patient have prior to the development of these symptoms??

A- CYANOSIS WITH JOINT PAIN
B- MENINGITIS
C - PHARYNGITIS
D- JAUNDICE
E - SKIN INFECTION




HIGHLIGHT HERE TO CHECK ANSWER------> **** C-pharyngitis.****


after uv read the answer can someone please explain to me what the diagnosis is.. cos i was clueless!!
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Old 02-04-2012
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its coxsackie B virus ...... i guess...

most common virus causing myocarditis and heart failure ...
also causes rash , URTI .......
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  #3  
Old 02-04-2012
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does it cause joint swelling?
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  #4  
Old 02-04-2012
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Ans C Pharyngitis

rheumatic fever -polyarthiritis , erythema marginatum

CHF is due to acute myocarditis due to rheumatic fever

its an educated guess,lets see . . .
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Old 02-04-2012
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yes it does just found it on net : joint swelling rash , myocarditis , pharyngitis ... all are caused by coxsackie B so appears to be it .......

it causes septic arthritis : http://arthritis.webmd.com/septic-ar...-and-treatment
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  #6  
Old 02-04-2012
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I doubt that its cocksakie becuase this condition is classical for rheumatic fever.

main criteria have 5 things-polyarthiritis ,myocarditis,subcutaneous nodules,erythema marginatum and syndenham's chorea.

minor have fever,raised ESR and etc

Pharyngitis precedes them

also in exam do not forget about aschoff bodies and anistchkow cells
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Old 02-04-2012
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I'll go with C.


young female ---> most common age and sex for rheumatic fever.
Early deaths are due to Myocarditis which happened here.
Painful joints and swelling
erythematous rash ---> erythema marginatum


The symptom that is confusing is the enlarged heart. Cox virus does cause a myocarditis leading to dilated cardiomyopathy, I don't know if RF myocarditis does as well???

Apart from that the other symptoms fit RF perfectly.
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  #8  
Old 02-05-2012
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C - pharyngitis
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Old 02-05-2012
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Quote:
Originally Posted by haga View Post

The symptom that is confusing is the enlarged heart. Cox virus does cause a myocarditis leading to dilated cardiomyopathy, I don't know if RF myocarditis does as well???

Apart from that the other symptoms fit RF perfectly.

RF does cause PANcarditis ie -- endo .. myo n pericarditis

my question is SO ACUTELY??
can RF cause death so ACUTELY?
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Old 02-05-2012
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yup that is why i think its coxsackie B , thinking of Bornholms disease " devil grip "

dont think RF would cause such severe myocarditis and death .....
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Old 02-05-2012
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this is a question from the 2010 free 150 questions..
so i think its kinda important.. n its really bugging me that i dont know what the diagnosis is!


is it coxsackie or RF?
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Old 02-05-2012
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Quote:
Originally Posted by mbbs2010 View Post
RF does cause PANcarditis ie -- endo .. myo n pericarditis

my question is SO ACUTELY??
can RF cause death so ACUTELY?
Yes RF can cause death due to acute myocarditis ,even first aids 2011 states that.

acute myocarditis leads to arrhythmia,that causes death . . . . FYI
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Old 02-05-2012
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well for such Qs , i think if they ask you these symptoms and what happened before think RF and mark pharyngitis because that is what RF and coxsackie both do so doesnot matter ..

if they ask you the causative organism , they might keep some more hint in it or the options may have all bacterias or all virsuses ,

if riding on bad luck and find both RF and coxsackie ....i think they will tell you something about ASO titer or esr , or a murmur of MR for you to select RF

if ASO high no doubt RF , if low coxsackie !!!!!
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Old 02-05-2012
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I think RF still fits,
Pt came to the ER with all the symptoms. Due to the complications of myocaditis, CHF, the pt died 2 days after.
The question asked before the development of all these symptoms, what had happened?
Then the answer would be Strep induced pharyngitis, of which the most feared complication is myocarditis/pancarditis, less severe complications being the valve complications. Sometimes, the heart complication does not develop within 5-8 weeks from the time of streptococcal pharyngitis but after years, then it is called rheumatic heart disease...
I agree that the question is unclear, lets hope that we don't have a lot of confusing Qs like this...:sorry:
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Old 02-05-2012
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in RF.. myocarditis causes arrythmias that causes death.

this patient develops CHF and dies .. 2 days later...
wudnt RF arrythmia kill u immediately?


coxsackie does cause Dilated cardiomyopathy.. so doesnt that fit better>??

or does RF cause acute CHF too?
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  #16  
Old 02-05-2012
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I think its Coxsackie so B. Meningitis.
RHD can be too but u have to keep it in mind here they are talking about cardiac enlargement which is most like associated with Coxsackie. RHD will also cause enlargement bt that of left atrium and RHD is a long standing process which takes years.
Now since they mentioned about acute CHF leading to death it points more towards Coxsackie virus.This is because RHD usually lead to rt sided heart failure and its a long standing process which should first lead to pulm hypertension followed by rt heart failure which i doubt can occur in such a short time.Ya arrythimia could have lead to acute death bt the question clearly mention pt develop intractable heart failure and dies sudden which is more likely to be for Coxsackie virus.
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  #17  
Old 02-25-2012
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Quote:
Originally Posted by mbbs2010 View Post
12 year old female patient comes with complaints of dyspnea, erythematous rash.

O/E-- it is associated with painful joint swellings of the knee and hip joints
there is cardiac enlargement and signs of pulmonary edema.

patient develops intractable CHF and dies 2 days later.

which of the following did the patient have prior to the development of these symptoms??

A- CYANOSIS WITH JOINT PAIN
B- MENINGITIS
C - PHARYNGITIS
D- JAUNDICE
E - SKIN INFECTION

So many ppl come up with 2 choices: acute RF (previous strep infection) or coxackie virus (does it need a previous infection?). I want to know which pathogen exactly causes this. The answer pharyngitis is good for either choice anyway.

I followed hitman 's link and found out painful swelling joints is the feature of bacterial infection 's arthritis. Aseptic arthritis is more slowly progressing and indolent.

I also think the important hints here are: rash, dilated cardiomyopathy, painful swelling knee and hip joints. The other signs and symptoms such as dysnea, pulmonary edema, congestive heart failure and cardio collapse could be the pathophysiologic consequence of dilated cardiomyopathy and CHF. If the myocarditis is affected in case of spreading endocarditis, then that focal lesion can create arrythmia and there you go...Besides, CHF put the patient at a high risk of mortality.

So do you think its a Coxackie infection or ARF?
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  #18  
Old 02-25-2012
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i dont think RF causes dialated cardiomyopathy, in fact it causes myocarditis (as part of the pancarditis) whereas coxsackie does cause dialated cardiomyopathy.
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  #19  
Old 08-05-2012
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that's really confusing question, but I think for the sake of the exam, we should go with the most common possibility? so I choose pharyngitis.

if that question was without those choices , I would think of lyme diease .
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