PROBLEM SOLVING IN CLINICAL PRACTICE
Age no barrier to diagnosis
1 Department of Paediatrics, Gloucester Hospitals NHS Trust, Gloucester, UK
2 Bristol Royal Hospital for Children, Bristol, UK
Correspondence to:
A V Ramanan, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, King David Building, Upper Maudlin Street, Bristol BS2 8BJ, UK; avramanan@hotmail.com
| The first 150 words of the full text of this article appear below. |
John was 14 years old when he was referred by his general practitioner (GP) with generalised stiffness in his legs and wrists for the past 4 days. His GP noted that his temperature was 39.5°C and had been raised for 2 days. John also complained of having had a frontal headache the previous day which had now resolved.
There was minimal past medical history though John had been diagnosed with ocular hypertension 2 years prior to current presentation which was currently being monitored; however, he was not on any ongoing treatment for this.
John had no known contact history and his immunisations were up to date. His mother was Japanese and his father was Caucasian.
On examination John was alert and orientated. His conjunctivae were both injected but they were not itchy or painful and there was no exudate. John had a cold sore on the right side of his
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