Reading through the information provided I now wonder if there was any arthritis in the first place. I think what the child had was an acute febrile illness associated with conjunctivitis and then developed a painful redness of the skin over both ankle and feet. This skin lesion may not have been an arthritis which seems more or less confirmed by the description of the absence of restriction of movements of the joints. The appearance of lymph nodes now indicates that there is a reticuloendothelial involvement either by an infection or infiltration. The presence of leucocytosis adds to the evidence of an infection and the differential would indicate viral versus bacterial etiology. Reading some of the responses got me thinking that maybe there was a Staph conjunctivitis which now is causing early lesions of a Staph Scalding Skin Syndrome as suggested by a previous discussant. Adenovirus could cause both conjunctivitis and arthritis but the arthritis is now suspect. A description of the conjunctivitis - edematous, purulent discharge would be appreciated and I wouldn't be surprised to see the erythematous rash worsening and showing a Koebner phenomenon. A Gram smear and culture would be needed along with Cloxacillin at the earliest.
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