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Infantile-Onset Fever and Urticaria
JAMA Pediatrics ( IF 24.7 ) Pub Date : 2017-11-01 , DOI: 10.1001/jamapediatrics.2017.2531 Sukesh Sukumaran 1 , Vini Vijayan 2
JAMA Pediatrics ( IF 24.7 ) Pub Date : 2017-11-01 , DOI: 10.1001/jamapediatrics.2017.2531 Sukesh Sukumaran 1 , Vini Vijayan 2
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A 5-year-old white girl presented with a history of recurrent fevers and urticaria since 2 months of age. The child had fevers (maximum temperature, 40°C) that lasted 3 to 5 days. Her mother reported that the fevers resolved spontaneously but continued to recur almost every month. The fever symptoms were associated with bilateral conjunctivitis, arthralgias, and irritability. The hivelike, nonpruritic urticaria did not improve with antihistamine medication and there were no known precipitating or aggravating factors. The child did not attend day care. Family history was noncontributory and her parents denied consanguinity. The child was hospitalized on multiple occasions during infancy for the fevers, and she had comprehensive sepsis evaluations, including lumbar punctures, with negative results. Findings from chest and abdominal imaging and bone marrow aspiration with biopsy were negative for a malignant process. Despite extensive evaluation, a definitive source for the fevers was not identified, and the patient was referred to our institution. On physical examination, the patient was febrile (temperature, 39°C) and appeared fussy. Growth measure findings were normal. Skin examination confirmed nonpruritic, macular and urticarial lesions on the face, back, and lower extremities (Figure). Bilateral conjunctival hyperemia without drainage was noted. There was neither swelling nor redness of the joints. Her right ankle and knee examination showed limited active and passive range of motion secondary to pain symptoms. Findings from the remainder of physical examination were normal.
中文翻译：
婴儿发热和荨麻疹
一名 5 岁的白人女孩自 2 个月大以来就有反复发烧和荨麻疹的病史。孩子发烧（最高温度，40°C），持续 3 至 5 天。她的母亲报告说，发烧会自然消退，但几乎每个月都会复发。发热症状与双侧结膜炎、关节痛和易怒有关。抗组胺药物治疗后，荨麻疹样、非瘙痒性荨麻疹没有改善，也没有已知的诱发或加重因素。孩子没有参加日托。家族史无贡献，她的父母否认有血缘关系。孩子在婴儿时期因发烧多次住院，她进行了全面的脓毒症评估，包括腰椎穿刺，结果均为阴性。胸部和腹部成像和骨髓穿刺活检结果显示恶性过程为阴性。尽管进行了广泛的评估，但仍未确定发热的确切来源，因此将该患者转诊至我们的机构。体格检查时，患者发热（体温 39°C）并出现烦躁不安。生长测量结果正常。皮肤检查证实面部、背部和下肢有非瘙痒性、黄斑和荨麻疹病变（图）。注意到没有引流的双侧结膜充血。关节没有肿胀和发红。她的右脚踝和膝盖检查显示继发于疼痛症状的主动和被动活动范围有限。其余体格检查结果正常。
更新日期：2017-11-01
中文翻译：
婴儿发热和荨麻疹
一名 5 岁的白人女孩自 2 个月大以来就有反复发烧和荨麻疹的病史。孩子发烧（最高温度，40°C），持续 3 至 5 天。她的母亲报告说，发烧会自然消退，但几乎每个月都会复发。发热症状与双侧结膜炎、关节痛和易怒有关。抗组胺药物治疗后，荨麻疹样、非瘙痒性荨麻疹没有改善，也没有已知的诱发或加重因素。孩子没有参加日托。家族史无贡献，她的父母否认有血缘关系。孩子在婴儿时期因发烧多次住院，她进行了全面的脓毒症评估，包括腰椎穿刺，结果均为阴性。胸部和腹部成像和骨髓穿刺活检结果显示恶性过程为阴性。尽管进行了广泛的评估，但仍未确定发热的确切来源，因此将该患者转诊至我们的机构。体格检查时，患者发热（体温 39°C）并出现烦躁不安。生长测量结果正常。皮肤检查证实面部、背部和下肢有非瘙痒性、黄斑和荨麻疹病变（图）。注意到没有引流的双侧结膜充血。关节没有肿胀和发红。她的右脚踝和膝盖检查显示继发于疼痛症状的主动和被动活动范围有限。其余体格检查结果正常。
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