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Old 08-24-2012
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Question Fever of unknown origin diagnosis?

A 3 yr old girl is brought to the pediatrician for fever. On p/e- fever is associated with generalized lymphadenopathy with no rash. Next day she begins to have swelling over her knees and elbows bilaterally. Her liver and spleen are found to be slightly enlarged. She has no vomiting or diarrhea.

What is the diagnosis?

a) Kawasaki disease
b) Fanconi syndrome
c) Felty syndrome
d) Still's disease
e) Septic arthritis
f) Klein-waardenburg syndrome


A brief explanation is essential!
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Old 08-24-2012
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a) kawasaki disease- desquamation isn't present
b) fanconi syndrome ...
c) felty syndrome - massive hepatosplenomegaly is characteristic
d) still's disease <- My Choice
e) septic arthritis - poliarticular?..!
f) klein-waardenburg syndrome- nothing of symptoms here are associated with KW.
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Old 08-24-2012
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I'll go with (d) "Still's disease" cos its common in children with fever,lymphadenopathy,joint pain.

what's making me doubtful about Still's disease is that there is pink coloured rash present but can be absent as well i guess,in the lot the best option is (d).still looking forward to the answer with explanation.
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Old 08-25-2012
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yes, the correct answer is D) still's disease----juvenile rheumatoid arthritis....both small and large joints are affected....rheumatoid factor is usually negative( if positive associate with poor prognosis).most common in between 1-3 yr old children

1.kawasaki----fever, rash, may lead to myocardial infarction
2.fanconi----due to expiry of tetracycline..type 2DKA ( normal aniongap met. acidosis. with hypokalemia)
3.felty syndrome-----triad of splenomegaly,leukopenia, rheumatoid arthritis.....affects adults mainly usually with known case of rheumatoid arthritis
5.septic arthrits----no need to explain i guess..but it's synovial fluid contain >30,000 WBC
6. klein waardenburg syndrome------mutation of PAX gene ,a homeo domain protein for transcription...c/f----dystopia canthorum,heterochromia irides( also seen in horner's), hypopigmentation.......
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