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What Causes Fever, Butterfly Rash On Face, Swollen Face, Fatigue And Joint Pain?

Posted on Mon, 13 Jun 2016

Question: My son has been ill the last couple of months with off and on low grade fever, butterfly rash on his face along with swelling in the face, neck and ears, fatigue, and joint pain. His MD had labs drawn last week and called today to report several abnormal results and stated he was being referred to Hematology/Oncology. His abnormals were : WBC 15,000, absolute neutrophils 12375 (82.5%), Monocytes were at the XXXXXXX of normal at 900, CRP was 30.0, Alkaline phosphatase was 273, ANA positive with a homogenous pattern and a 1:160 ratio. I was thinking Lupus but I am worried that it could possibly be something even more serious. He is a 17 year old male and I should mention he has had Alopecia for about five years now. Your thoughts?

Answered by Dr. Dr. Pradeep Kumar Jain (3 hours later)

Brief Answer:
Get dsDNA done to confirm lupus

Detailed Answer:
Hello

Thanks for asking on this platform

I have gone through the detail and do understand your concern.In view of on &off fever,alopecia,malar rash and joint pain all these symptoms with positive ANA; it appears to be some form of connective tissue disorder most likely lupus.The XXXXXXX association of Rheumatology has given some criteria for the diagnosis of lupus and your son is fulfilling those criteria.
Here fever can be due to some infection or inflammation itself.ANA is the screening test and can be positive in any connective tissue disorder.
So in addition to the previous investigations I would like to get blood culture (to check whether fever is due to any bacterial infection),ESR to make the diagnosis more suggestive and dsDNA(confirmatory for lupus) test done.Lupus is a multiorgan disease so other investigations to find involvement of kidney,heart or lung should also be done.
Till then continue conservative management as advised by your physician.
Please let me know if you have any more query.
Wishing for your son's good health.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Pradeep Kumar Jain (7 hours later)

He did have a Sed rest done and it was only 2.0. I am a nurse and have tried to analyze his labs but it seems that most of them coincide with a certain disease with the exception of one value and so on... I had a friend who is an NP analyze his labs and she suggested Mono, however his Lymphocytes are not elevated in fact they are 1700 which is on the lower spectrum of normal, the WBC was elevated but the differential shows he is neutrophilic, so I feel that Mono is not a strong possibility at this point.

Answered by Dr. Dr. Pradeep Kumar Jain (7 hours later)

Brief Answer:
Chances of having mono is remote

Detailed Answer:
Thanks for follow up

You are right.The symptoms match with the mono but the lab findings are not suggestive.So still my provisional diagnosis would be some connective tissue disorder most likely lupus.
I request you to attach the reports so that I better able to analyse it and would try to help you out.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar