SALIENT FEATURES

General Data:
7 yrs. old
Female
Asian (Filipino)

CHIEF COMPLAINT
Fever

IMPRESSION:
T/c Systemic Lupus Erythematosus

DIFFERENTIAL DIAGNOSES:
Systemic Juvenile Rheumatoid Arthritis (JRA)
It is the most common chronic rheumatologic disease in children and is one of the most common chronic
diseases of childhood. It is idiopathic synovitis of the peripheral joints with soft tissue swelling and
effusion. Its peak incidence is at 1-3 years old with female predominance. Essentials of diagnosis and
typical features are arthritis, involving pain, swelling, warmth, tenderness, morning stiffness, and
decreased range of motion of one or more joints, lasting 6–12 weeks. It may also have associated
systemic manifestations, including persistent daily fever (Quotidian pattern with temperature spikes of 39
°C for 2 weeks), rash, uveitis, serositis, anemia, fatigue, and growth failure.

RULE IN RULE OUT

(+) 7 years old (age onset <16 y/o)
(+) female
(+) pain on lower extremity when trying to move
(especially in the morning; Painscale of 8/10)
(+) joint pain
(+) easy fatigability
(-) duration of joint pain 6-12 weeks (8 days only
prior to admission)
(-) uveitis
(-) persistent daily temperature spikes of 39°C
(-) faint red macular rash over the trunk and
proximal extremities
(-) duration of disease >/= 6 weeks

Erythema Infectiosum (5th Disease)

It is caused by the Human Parvovirus B19, a single-stranded DNA virus. This is a benign viral exanthema
in healthy children. This usually begins with a mild, nonspecific illness characterized by fever, malaise,
myalgias and headache. Its transmission is by respiratory secretions and by blood product transfusions.
The incubation period is typically 4-14 days and rarely may last to 21 days.

RULE IN RULE OUT

(+) Malar Rash (-) Rash on other parts of the body such as trunk
that appeared 1-4 days later since the appearance of
(+) body weakness rash on the cheeks
(-) Pruritis of rash
(-) Low-grade fever
(-) headache
(-) myalgia
(-) pharyngitis
(-) conjunctivitis
(-) no history of blood transfusions

Epstein – Barr Virus Infection

Infectious Mononucleosis is the best- known clinical syndrome caused by Epstein- Barr virus (EBV). It is
characterized by systemic complaints consists primarily of fatigue, malaise, fever, sore throat, and
generalized lymphadenopathy.

RULE IN RULE OUT

(+) fever (-) lymphadenopathy
(+) body weakness (-) sore throat
(+) easy fatigability (-) abdominal pain
(+) splenomegaly (-) headache
(+) hepatomegaly (-) nausea

Acute Lymphoblastic Leukemia (ALL)

Childhood ALL was the first disseminated cancer shown to be curable. It is a heterogeneous group of
malignancies with several unique genetic abnormalities that result in varying clinical behaviors and
responses to therapy. It is common in individuals <15 years of age. ALL has a peak incidence at 2-3 yrs.
of age and occurs more in boys than in girls at all ages. This peak incidence in white population

RULE IN RULE OUT

(+) 7 years old (-) Wheezing
(+) Fatigue (-) Lymphadenopathy
(+) Malaise (-) Pallor
(-) Fever (low grade) (-) Purpuric and petechial skin lesions
(+) Splenomegaly (-) Mucous membrane lesions
(+) Hepatomegaly (less common)
(+) Joint pain in the lower extremeties

Mixed Connective Tissue Disease

MCTD is a rare systemic autoimmune disease with a lapping feature of at least two connective tissue
diseases namely Systemic Lupus Erythematosus (SLE), Systemic Sclerosis (SSc), Polymyositis (PM),
Dermatomyositis (DM) and rheumatoid arthritis (RA). MCTD has no unique clinical features, and there is
a considerable inter-individual variation in clinical manifestations. Approximately 80% exhibiting this
disease are women.

RULE IN RULE OUT

(+) Malaise (-) Dyspnea
(-) Fever (low grade) (-) Wheezing
(+) Malar rash (-) Raynaud phenomenon
(+) Joint pain (more severe than in SLE) (-) Swollen or “sausage-like” fingers
(+) Fatigue

Rheumatic fever
Rheumatic fever is a rare and complex disease that affects the joints, skin, heart, blood vessels, and brain.
It usually develops after Group A streptococcal throat infection in genetically vulnerable individual It is
commonly seen in developing countries. It occurs mostly in children between the ages of 5 to 15.

RULE IN RULE OUT

(+) 7 years old (-) Carditis
(-) Rashes (trunk and extremities) (-) Polyarthritis (sa knee joint lang ba?)
(+) Fever (-) Subcutaneous nodules
(+) Joint pain (-) Chorea