Reactive arthritis- This autoimmune condition often develops in response to infection. Considering Miah’s recent URI, fever and current symptoms, this should be considered as a differential diagnosis. Juvenile rheumatoid arthritis- This should be included as a differential diagnosis because it often presents by affecting a single or multiple joint and includes symptoms such as fever, joint stiffness, pain
and swelling. Other symptoms that are common with this that Miah did not present with includes swollen lymph nodes and rash (Kent et al., 2018). Septic arthritis- This is an infection in joints that can cause systemic symptoms. This is a must-not-miss diagnosis and should be considered due to Miah’s recent URI and symptoms of joint pain and joint swelling. Her lack of fever helps distract the thought of this being the leading diagnosis but missing this could lead to serious consequences. 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?Treatment for Miah includes admission to the hospital for adequate IV hydration and pain control. She will need monitored for acute chest syndrome, respiratory distress syndrome, temperature elevation (sign of sepsis), and splenic sequestration (Kent et al., 2018). If she develops a fever, blood should be drawn for culture and sensitivity and IV antibiotics may be needed pending the results. Inpatient treatment for pain control includes IV Ketorolac in conjunction with narcotics (morphine) every 4-6 hours. Development of unilateral swelling to hands or feet would indicate the need for a biopsy and culture of the bone to rule out osteomyelitis (Kent et al., 2018). Monitor Miah’s for signs of splenic sequestration, a common complication in children with sickle cell anemia. Tender spleen is a common
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- Summer '17
- Hematology, Sickle-cell disease, Miah Zavarro