The presence of a short duration acute febrile illness associated with more than one system involvement - conjunctivitis, arthritis, hepatomegaly - may indicate an infectious, malignancy or a connective tissue disorder at the first glance. However, whenever there is arthritis one must keep in mind an Acute Leukemia which has lead many a time to a downfall of clinical skills. Viral infections could cause an acute febrile illness associated with arthritis and a tender hepatomegaly. Connective tissue disorders could present however time will tell if the symptoms persist. Leukemia needs repeated blood counts and smears and clinical examinations for lymphadenopathy and the appearance of a spleen, etc. Maybe we need a history of drug intake, past history of serum products, basic blood count and a smear to begin with our approach.
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