In this specific case study, the following physical exam results are most concerning to this practitioner.Splenomegaly- Enlarged spleen in children can point to a variety of diseases. An enlarged spleen can be caused by infections, cirrhosis and other liver diseases, blood diseases characterized by abnormal blood cells, problems with the lymph system, or other conditions.Yellow Sclera- Though very common in children, a yellow sclera can be a sign of jaundice and need to be evaluated thoroughly.Dactylitis - Dactylitis may be the first symptom in people with sickle cell disease, especially in children. It can appear in infants as young as 6 months old. When dactylitis occurs as a side effect of sickle cell disease, it can be accompanied by a fever, pain, and an increase in white blood cells. The three differential diagnoses in this case are:
Septic arthritisSeptic arthritis is a painful infection in a joint. The infection can come from germs that travel through your bloodstream from another part of your body. Septic arthritis can also occur when a penetrating injury delivers germs directly into the joint. This is a reasonable alternative hypothesis for this case. Ruled out due to lack of fever. Reactive arthritisReactive arthritis occurs when the body’s immune system reacts to a recent infection, usually within the past four to six weeks, with joint swelling and pain. The child has recovered from the infection and, several weeks later, develops the signs of reactive arthritis. Likely diagnosis in this case due to cold and fever last week. Ruled out due to presence of autoimmune disorder.Psoriatic arthritisPsoriatic arthritis is a form of arthritis associated with psoriasis, a chronic skin and nail disease characterized by red, scaly rashes and thick, pitted fingernails. The disease is like rheumatoid arthritis in symptoms, characterized by joint inflammation. However, psoriatic arthritis tends to affect fewer joints than rheumatoid arthritis and does not produce the typical rheumatoid arthritis antibodies. Ruled out due to lack of rashes on body and pitting on fingernails.In SCD, the spleen doesn’t work properly or doesn’t work at all. This problem makes people with SCD more likely to get severe infections. What is the treatment for Miah and education for the family?Sickle cell disease is an autoimmune disorder. Signs and symptoms of sickle cell disease usually begin in early childhood. Characteristic features of this disorder include a low number of red blood cells (anemia), repeated infections, and periodic episodes of pain. The severity of symptoms varies from person to person. Some people have mild symptoms, while others are frequently hospitalized for more serious complications. Treatment of sickle cell disease involves management of symptoms.
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- Summer '17
- Sickle-cell disease, MIAH