Reference no: EM133249156

CASE

Angelo Hingal, 5 years old, male child presents to the outpatient clinic with a history of fever, rash in trunk, a swollen knee and ankle with pain and limitation of movements, and occasional chest pain. His past medical history is significant for the fact that he had a Streptococcal sore throat infection 3 weeks prior to this visit but did not take any antimicrobial. that was prescribed.

Past Medical History: Patient had frequent Upper Respiratory Tract that varies from Common colds and Tonsillopharyngitis in previous years. No consultations done for the past 2 to 3 years because of the pandemic.

General survey: conscious, coherent, irritable, under nourished, in mild cardio - respiratory distress.

Vital signs: BP: 90/60 mmHg CAR: 110 beats/min.

RR: 40/min. Temp: 38.5°C.

HEENT: slightly nasal congestion, pale palpebral conjunctiva,hyperemic tonsillo- pharyngeal area

Neck: supple, (+) cervical lymphadenopathies

Chest/ Lung: slight intercostal retractions, harsh breath sounds, mucus rales on both lung fields, no wheezes

Heart: dynamic precordium, thrill at cardiac apex, systolic grade 2/6 systolic regurgitant murmur heard best at the apex and an S3 gallop.

Abdomen: slight globular, Normoactive bowel sounds, liver size 9 cm at the level of the right MCL.

Extremities: good peripheral pulses, pitting edema at ankle.

Laboratory Tests: CBC: Hgb: 11gms % WBC:14,000/dl predominance of segmenters

ESR: elevated CRP: (+) ASO titer > 200

Chest x-ray: enlarge left ventricular shadow wiRith pulmonary congestion

Question 1: Based on the salient features of the patient, what is the diagnosis? Justify.

Question 2: What are the differential diseases to consider? Why?