Systemic Juvenile

Acute Rheumatic Stevenson-johnson

Idiopathic Arthritis (JIA) Scarlet Fever Rocky mountain Spotted fever Measles Kawasaki
Fever syndrome
– Stills disease

Self-limited (<10 days) Acute illness 3-4 Sver bullous form of Rickettsial infxn 4mo-4 years
weeks after Strep erythema multiforme Tick bite
infection

 Prolonged Fever  Fever (<5 days)  Migratory  High fever (<7 days)  Fever  Exudative  High fever >5 days (unresponsive to
 Irritable  Cervical Lymphadenopathy polyarthritis  Constituational sx  Headache conjunctivitis antibiotics)
 Diffuse (usually bilateral)  Carditis (Chronic  Severe stomatitis  Abdominal pain  Koplik spots in mouth  Significant irritability
Lymphadenopathy  URI (Pharyngitis) valvular dz if not  Conjunctivitis  Vomiting (red lesions w/ bluish  Conjunctivitis (no exudate)
 Arthritis present >6  Strawberry tongue treated)  Irritable  Diarrhea white spots in center)  Mucosal oral erythema w/ strawberry
weeks  Chorea  followed by severe myalgias  Cough tongue (NO oral exudates)
 Visceral involvement: NO LIP or EYE involvement  Coryza  Dry, cracked lips
hepatosplenomegaly,  Generalized  Swelling + erythema of hands and
serositis lymphadenopathy w/ feet desquamanation in 2nd week
splenomegaly  Unilateral,cervical lymphadenopathy
(mobile, non-tender)
 Polyarthralgia – refuse to walk (d/t
painful swollen feet)
 Coronary aneurysms

 Fine, salmon pink
 Trunk, prox
extremities, NOT face
 Accompanies spikes of
fever and disappears
when fever down
 Diffuse, fine papular Subq nodules  Erythema multiforme  Rose-red blanching macular  Maculopapular rash  Diffuse, maculopapular erythematous
erythematous – blanches! Erythema marginatum rash (hypersensitivity rash  Behind ears, neck,  Palm + soles
 “Sand paper texture” rxn)  Wrists + ankles entire body hairline  downward
 Neck, axillae, groin   Blistering rash –  Palms + soles to feet in 2-3 days
trunk and extremities purpuric macules on  After several days becomes
 Circumforal pallor face/trunk petechial or hemorrhagic w/
 Resolution:  Maculopapular rash evidence of palpable purpura
Desquamanation face   Mucous membrane
down involvement

Anemia + Strep throat culture OR + Strep throat culture Clinical dx Clinical dx Clinical dx CBC: Anemia (normochromic, normocytic),
  ESR + CRP OR  WBCs, ( neutrophils)
+ streptozyme or ASO serology  LFTs Indirect fluorescent Ab for R.  platelets
+ streptozyme or ASO rickettsii  ESR + CRP
serology  LFTs
Echocardiogram (coronary dilations or
aneurysms)

Important to treat to prevent IV immunoglobulin

rheumatic fever! Aspirin

Enterovirus (Coxsackievirus)
Meningococcemia Roseola Varicella
Hand-Foot-mouth
Neisseria meningitides Children <2 Self-limited (<1 week)
 Abrupt onset – Fever, chills, malaise,  Rash preceded by 3-4 days of high fevers  Mild fever  High fever (only a few days)
prostration  Late summer/early fall
 Initially: urticarial, maculopapular or  Macular or maculopapular rash  Trunk  extremities + head  Erythematous, maculopapular
petechial (marked by small, purplish  Trunk  arms + neck  Erythemetous  macule  papule  vesicle  Vesicles on hands + feet
hemorrhagic spots)  Less involvement of face and legs  pustule  crust  Ulcers in mouth
 Fulminant  Various stages of development

Unilateral cervical lymphadenopathy :

 Bacterial Cervical adenitis  Children 1-6 w/ hx of URI (Staph. Aureus, Strep. Pyogenes) – High fevers and toxi appearance. Overlying cellulits and development of fluctulance

 Cat scratch disease  Chronic regional lymphadenitis 2-3 weeks post bite; LN tender + erythematous; hx of kitten exposure
Parinaud occuloglandular syndrome (unilateral conjunctivitis, preauricular lymphadenopathy + cervical lymphadenopathy) after frubbing eye w/ hand after cat contact
Dx: Tissue specimen - Warthin-Starry stain: gram neg. bacilli
Tx: resolves in 2-4 mo

 Reactive node from pharyngitis

 Kawasaki

 Mycobacterial infection: Overlying skin initially erythematous, if left untreated  violaceous, drain through skin  draining sinus tract
Tx: surgical excision
o TB: >12 yo
o Atypical mycobacteria: 2-4 yo, PPD rx +, but <10 mm

 Mononucleosis  Fever, malaise, fatigue, headache; pharyngitis w/ exudates + petechiae; generalized lymphadenopathy, splenomegaly
Dx: Peripheral smear = atypical lymphocytes; serologic testing confirms
Tx: Supportive care. Avoid contact sports.
 Lymphoma
 Tumors: thyroglossal duct cyst, branchial cleft cysts, cystic hygroma, mumps