The information given can be looked at under the following headings.
1.Fever
2.Exanthem
3.Conjunctivits
4.Painful ankle joint.
One clarification is required, how could one elicit ankle joint tenderness when both
the joints were in a cast at the time of presentation?!
Presuming that the child had fever and joint involvement as the presenting symptom, and the POP was applied because of joint swelling, the combination of fever, joint pain and exanthema suggest one of 3 possibilities
a) Viral/rickettsial exanthem and arthritis. If the rashes are involving the palms and soles, the child being irritable and joint swellings, rickettsial fever (endemic typhus) comes in to picture
the additional history one would like to ask will be history of travel, pets at home and the distribution of rash
b) Drugs given for fever especially penicillins could cause a serum sickness like illness leading to joint pain and swelling and rashes. I would like to know whether any drugs were given
c) Juvenile rheumatoid arthritis can have high fever, joint involvement and rash. One would again be happy with the description of the rash
d) Conjunctivitis, joint involvement can make it a viral infection
e) Reiter syndrome (arthritis, urethritis, conjunctivitis) is uncommon in children but should be considered in those with pauciarticular disease type II.
f) Palpebral conjunctivitis in the febrile patient may be a clue to measles, coxsackievirus infection, tuberculosis, infectious mononucleosis, lymphogranuloma venereum, cat-scratch disease, or Newcastle disease virus infection.
g) In contrast, bulbar conjunctivitis in a child with FUO suggests Kawasaki syndrome or leptospirosis.
h) Petechial conjunctival hemorrhages suggest endocarditis. Uveitis suggests sarcoidosis, juvenile rheumatoid arthritis, systemic lupus erythematosus, Kawasaki syndrome,
Behçcet syndrome, and vasculitis.
i) Uncommon manifestations of meningococcal disease include septic arthritis, Primary purulent conjunctivitis can lead to invasive disease. Sinusitis, otitis media, and periorbital cellulites also can be caused by the meningococcus.
j) C. diphtheriae occasionally causes mucocutaneous infections at other sites, such as the ear (otitis externa), eye (purulent and ulcerative conjunctivitis), Sporadic cases of pyogenic arthritis, mainly due to nontoxigenic strains, are reported in adults and children.
k) Rectal prolapse, toxic megacolon or pseudomembranous colitis (usually associated with S. dysenteriae), cholestatic hepatitis, conjunctivitis, iritis, corneal ulcers, pneumonia, arthritis (usually 2 -5 wk after enteritis),
The list appears endless as the initial information is rather limited. But this should open up the discussion.
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