Hi, my son has felt unwell for some weeks now

Patient : Hi, my son has felt unwell for some weeks now. Main symptoms are a rash, knee joint pain, fatigue, headaches, sore throat etc. We have been to the doctors and the hospital who, after tests (blood, urine) diagnosed a virus. It has been nearly 3 weeks now and I'm concerned it could be something more serious. When you read about these symptoms it points to some very nasty diseases such as Leukemia. Although I assume this would stand out in the blood work.
Symptoms:  Knee joint pain, fatigue, rash (diagnosed as urtacaria) sore throat.
Doctor :   Hello, Thanks for posting your query at ATD Symptom profile my indicate to many etiologies but its the investigation t hat confirms or rules out the probable diagnosis. Leukemia although it presents with same symptoms but there are numerous signs on general examination and then blood workup would have shown presence of excessive number of abnormal cells. Also viral infecrion with rash & joint pain is much more common than leukemia. Then comes some other etiologies before a provisional diagnosis of leukemia is made. Lastly the symptom profile of leukemia is a crescendo type which means symptoms hardly settle down and there is worsening of symptoms without medication/treatment specific for leukemia whereas viral arthritis/ urticaria slowly settles with supportive medication. Post viral arthritic pain are slow to resolve may even take 3-4months. Recovery is quick in children. In adults it may take up to a year. This is a self limiting condition with medicine and hot fomentation playing a supportive role rather than a curative role. I hope your query is answered. If there are any more doubts, please feel free to write to us. Regards

Comments / Follow Ups

Patient: Thank you for your response. I've just been quite concerned that it could be something more sinister, but it's good to have confirmation that something like Leukemia would present other signs and symptoms, and that blood work would indicate abnormalities which would then require further investigation. He has now been sent for an ASOT blood test which I think would detect something like viral arthritis.
Doctor: Hi,
Thanks for your positive response.
ASOT test is for detection of concentration of bacterial agent in body. It us antistreptolysin O titre estimation test. To detect streococcal infection.
Keep me posted of results.
Patient: Hi, We have just had more extensive blood test back and I am concerned at the results. There is eveidence of significant infection - high white blood cell count - raised platelet - high CRP and high ferritin. Also high antistreptolysin suggesting recent infection. Any thoughts on these results?
Doctor: Your son had streptococcal bacterial infection as suggested by high anti streptomycin titre and reflected by high CRP & WBC count. He had all the symptoms suggesting of a infection from clinical profile as suggested in my first answer and viral or bacterial could only be assessed from examination and investigation which now points towards a bacterial etiology.
Now it is important to see his present symptom profile that the symptoms present and their intensity to clinically determine the role of antibiotics as nearly 4 weeks have already passed. Secondly follow up blood work is to be observed whether counts and CRPlevels remains elevated suggesting infection or decreasing counts indicating settling down of infection.
Feel free to discuss.
Patient: Hi. I meant to thank you for your follow up comments the other week. Although the fever/rash have settled down, though not completely gone, the joint pain has graduated to the hip as well as the left knee. We have an appointment with a Pediatrician on the 18th May, where hopefully we can get more answers. In the meantime my son remains in pain with the joints and a general feeling of unwellness. Regards Mark
Doctor: Hi,
Post infective arthritis is common and sometimes takes weeks to months to settle down. Hip pain can be referred to knee as well due to related nerve supply. Also in children post infective transient synovitis of hip is often observed. Consult your paediatrician regarding the same and get xray of pelvis with both hips to rule out structural pathology of hip.
Wish your child good health and speedy recovery.

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