Now Normal ESR rules out JRA and other connective tissue disorders. Hb is low for age but not low enough to think of any marrow infiltrative disorders like ALL to be considered at the moment but has to be kept in mind. Going by the progress of the child it still looks like an acute viral illness with arthritis. Relatively high total count of 16,000 cells may suggest a possibility of pyogenic arthritis but bilateral involvement and rash do not fit into pyogenic arthritis. No history of blood and blood products still does not rule out serum sickness.
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