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- Mon Jul 23, 2007 12:23 pm
I have a 10 yr old daughter who is an active gymnast. She has been having off and on fevers for the past 9 months. She now complains of joint pain. She has a lacey looking rash on her thigh. It is not raised or itchy. She has frequent headaches. Labs were done and show the following flags:
WBC 3.5 (4.0-13.5 ideal)
Neutrophils 41 (48-73 ideal)
Neutrophils(Absolute) 1.4 (1.5-7.8 ideal)
Her sed rate was normal
Her TSH normal
C-reactive protien- normal
Rhumetoid Arthritis Factor- normal
ANA w/ reflex- normal.
What else should I be asking about?
Thank you for your help.
| Dr. Chan Lowe
- Tue Jul 24, 2007 4:09 pm
It may be that your daughter is having recurrent viral infections (that can cause fevers, joint pain and rashes). This is very common for children and can cause a drop in the WBC count.
I am a little suspicious of one other thing. Juvenile idiopathic arthritis (formerly called juvenile rheumatoid arthritis) can present with fevers, a rash and joint pain. The ANA and rheumatoid factor are generally negative with this disease. The fevers generally come in the afternoon and can make the child feel quite bad, then when the fever is gone the child is well appearing again.
To make a formal diagnosis, there needs to be at least six weeks of joint inflammation.
A newer lab study that seems to be helpful in diagnosing JIA is called anti-cyclic citrullinated peptide antibodies.
If her joint pain and fevers continue I would recommend she see a pediatric rheumatologist if possible. (They are a little few in number so there may not be one around if you are in a smaller area. In this case, there may be an adult rheumatologist that is familiar with pediatric rheumatology that can help.)
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