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?