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JOINT PAIN and rash in chest. R FEVER?

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Okay briefly-21 year old son-healthy at college. Few weeks back developed foot sensitivity then joint pain primarily in knee, ankle, wrist, but intermittent. Developed rash on chest/back. Tufts clinic suspects Lyme-put on antibiotics. Went for follow up to infectious disease specialist. He took 6 vials of blood. Ruled out Lyme took Will off antibiotics-he took them for 1 week. All blood tests negative and normal except one marker elevated that indicates inflammation. Infectious disese guy suspects virus, said remote possibility auto-immune and referred Will for follow up with dermatologist to look at rash. Meanwhile rash is mostly gone and he seems to feel better. But it does seem to come and go a bit. Please note he never felt sick. Advil helps joint pain and he is not tired or flu like or anything. My concern is that my son Googled his rash type and looked at pictures of different rashes (I know we all do this nowadays!) and said his rash looks exactly like the rash associated with Rheumatic Fever. Then Dr. Mom Googles R Fever and the symptoms fit ! Joint paint, rash and brief intermittent low-grade fever, elevated inflammation. SO my question: Wouldn't the infectious disease guy test for R fever or see evidence in tests he did? At any rate-if this is the problem he should get further treatment correct? He only had 1 week of antibiotics. He says he feels good now and is in Philly with friends as we speak. I am worried about possible heart damage if it is R fever.


Category: Family Physician-GP

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello.
Thank you for your query at DoctorSpring.com
I understand your concern.
The issue with most viral infections are that their manifestations are extremely varied, and it becomes difficult to pin point the exact infection. In fact there is a term called viral arthritis, a self limiting disease where a patient gets joint pain along with fever, and it is self limiting, resolving within 2 weeks.
In your son's case you're right, some of the symptoms do suggest RF. Most RF cases start with a throat infection and then the joints get involved. But they have more of a migratory polyarthritis ( multiple joint involvement ), and even the rash is erythmea marginatum, where there are small circular eruptions mostly involving the trunk and upper extremities. So what goes against our assumption of him having RF is this rash which you said is more in the chest region and back.
However since most other causes such as Lyme's disease has been ruled out, it is better if we rule out ARF too. I will advise you to get his ASO titre test done and that will give a more clearer picture. Along with that i will advise you to get ESR and CRP test done for him. With these 3 values, ARF diagnosis can be established/ruled out.
Hope this was helpful,
Regards.


Patient replied :

If it is RF-is it treatable?


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello.
Yes it is definitely treatable.
RF takes time to develop into Rheumatic Heart Disease.
The treatment required is 3 weeks of Penicillin/ Erythromycin.
And moreover it is a bacterial infection, hence if treated early there are no future worries.
It won't be prudent to start the treatment without getting the ASO titre results. So once you get them done, let me know.
Kind regards


Dr. Deepu Sebin Sebastian
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Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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