Joint pain and fever in a 15 year old

5/29/2008

I saw a young man with Trisomy 21 (Down syndrome) who has been having pain in his hand for 24 hours along with a low grade fever. He has a history of Celiac Disease or gluten enteropathy (sensitivity to the primary component of wheat products). This entity is very common in children with Trisomy 21 (Down syndrome) and can cause a number of symptoms including bloating, loose stools and growth failure. In cases where the dietary management is not complied with, there can be inflammatory complications such as joint pain. All children with Trisomy 21 (Down syndrome) should be screened for Celiac Disease as part of their routine screenings as it is present in nearly 25% of individuals with Trisomy 21.

This young man has had joint pain in the past and has undergone a complete workup by a pediatric rheumatologist who has concluded that his occasional joint pain is not Celiac related or the result of arthritis.

On examination today, the young man has a red throat and a low grade fever but no joint swelling. He complains of pain in both hands. A rapid throat culture antigen test revealed a strep throat infection. He was treated with a course of Amoxicillin for ten days. The hand pain resolved within 24 hours of treatment.

Joint or extremity pain is a common accompaniment of a strep throat in children and teens. Any child with an unexplained limp or joint pain should have a throat culture as part of the evaluation.

      

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