Patient Management Problem: Arthritis with a Rash
Mohsen Ziai MD1
1 Professor of Pediatrics, the University of Rochester School of Medicine and Dentistry, and Chief of Pediatrics, Rochester General Hospital, Rochester, New York
A 16-year-old black girl was admitted to the hospital with the complaint of painful right knee and skin lesions. Three weeks prior to admission the patient had felt somewhat fatigued and had had a sore throat, and the next day she developed a temperature of 102 F with shaking chills. At that time she had pain in both wrists and in back of both knees. On the following day while still somewhat febrile she noted the onset of sores on her skin which began as flat, red, painful spots over the hands and subsequently over both feet. These eventually desquamated and were on both wrists and palms, the left elbow, and over both soles and feet. Pain in her extremities was intermittent lasting about two or three days at a time in any one location. It involved the wrists, the knees, and the ankles; these pains were not accompanied by frank swelling but did interfere with proper movement of the joints. New crops of skin lesions continued to appear while the old ones desquamated. She did not measure her body temperature but did not feel feverish. Two days prior to admission she noted intense pain in her right knee which at this time appeared swollen and tender.
