A previously healthy 13-year-old girl is transferred to the PICU in respiratory distress. Her symptoms began 4 weeks before her PICU admission with right-sided hip pain that progressed to involve the lower back. This was followed by intermittent pain, swelling, and stiffness of the bilateral ankles and metacarpophalangeal joints, as well as an intermittent nonblanching rash that appeared over the extensor surfaces of her elbows and lower extremities. The patient has a strong family history of rheumatologic disease, and her pediatrician ordered a preliminary rheumatologic evaluation as an outpatient. She was found to have elevated inflammatory markers with positive rheumatoid factor and negative antinuclear antibodies. An appointment with rheumatology is scheduled for several weeks later. She does not undergo urinalysis at this time.
One week before the PICU admission she developed a sore throat that was treated with amoxicillin. A few days later she developed a temperature as high as...
Comments