1283 When the Fever is Not Infection…

Abstract

Background and aims: The systemic form of juvenile idiopathic arthritis (JIA) comprises 10- 20% of all JIA cases. The diagnosis is based on the association of the fever >6 weeks of duration with the arthritis, but the latter can be absent in the beginning. Methods: Discussion of a case. Results: AFAC, 6 years-old female, previously healthy. She went to our hospital because of vesperine fever with 12 days of evolution, accompanied by claudication and bilateral knee pain, without local inflammatory signs. On the admission she was febrile and she had a pinky macular rash in the trunk that resolved spontaneously. The rest of the exam was normal. The analysis revealed mild anemia (10.9g/dL), moderate leukocytosis with neutrophilia, thrombocytosis, elevated reactive Cprotein (9.9mg/dL) and erythrocyte sedimentation rate (113mm). The cultures, immunologic study, viral serologies, Widal, Wright and Weil-Felix reactions did not reveal any change, as well as the chest radiography, echocardiogram and Mantoux test. During the internment she maintained the fever (1 episode/day), accompanied by migratory arthralgia (big joints), with alleviation with ibuprofen (7mg/ kg/dose). At day 6 inflammatory signs (redness and edema) were present in her right elbow. She was discharged only with ibuprofen, but now she is treated with metotrexato and deflazacort, with good response. Conclusions: With this case, we want to emphasize an uncommon disease, which diagnosis is based on the clinical findings, since the laboratory is not specific. The confusion with infection is very frequent and can lead to unnecessary prescription of antibiotics.