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Volume 2 Number 5
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FELLOW CHALLENGE NOVEMBER-DECEMBER
2004 A 15 year old male
has had a rash on his chest for 10 months. The rash has responded poorly
to topical creams. He has also experienced low grade fevers intermittently
and severe joint pains. He has had no other rashes. His review of systems is negative for swollen
joints, high fevers, weight loss, mouth ulcers, alopecia, Raynaud’s, muscle weakness,
color changes to his extremities, or hyperesthesia.
Physical exam reveals a health appearing adolescent male in no
distress. He has a prominent raised, red rash on his chest (Figure 1).
His knees and elbows are tender and painful on range of motion. There
is no joint swelling or limitation of motion. He has no muscle weakness.
He has no enlarged lymph nodes, enlarged liver or spleen, heart or lung
findings, mouth sores or palatal rash. The rest of his exam is normal.
Lab tests reveal hemoglobin of 10 g%, a WBC of 6500 cells/mm3. The platelet count is 480,000 cells/mm3. The ESR is 118 mm/hour. The chemistries
and urinalysis are normal. The ANA and RF are negative. Blood cultures
are negative. The bone scan is positive for increased uptake in multiple
extremity bones. A. Your diagnosis is: _______________________
1.
Tuberculosis
2.
Psoriatic arthritis
3.
Chronic multicentric osteomyelitis
4.
SAPHO syndrome
5.
Systemic onset JIA
6.
Reactive arthritis B. The teen improves dramatically over the
next year on which medication (ESR decreases to 13 mm/hour)?
1.
Naproxen
2.
Solumedrol pulses
3.
Cyclophosphamide
4.
Thalidomide
5.
Methotrexate
6.
Colchicine Please e-mail or fax your answer to We are grateful to Sujata Sawhney of |
Figure 2