Toxic Shock Rheumatic Fever 1.2012.2
-
Upload
robin-dretler -
Category
Documents
-
view
2.164 -
download
0
Transcript of Toxic Shock Rheumatic Fever 1.2012.2
ROBIN HENRY DRETLER MD;FIDSA1/20/2012
HPI: 67 yom rigor followed by fever, severe diarrhea. Saw PCP and given Cipro. After 1 dose developed severe joint pains and came to EW.
Fever, hypotension, rash, bandemia and toxicity. Admitted on vanco, zosyn, cipro, doxycycline. ID consulted.
No resp or urinary sxs, no HA or stiff neck, no skin wounds, no IVDA, less diarrhea more painful joints.
SH: married, monogamous, no tob, min alcohol
FH: HTN
PE: Toxic, hypotensive, tachcardia Skin: diffuse erythema back of wrist and
forearm, both ankles, red palms, medial thighs, right knee red and hot
Diffuse erythema Erythema marginatum
Cardiac: no murmur Lungs: clear Abd: nl BS, neg Murphy’s Ext: L knee, R knee, R wrist all swollen, hot,
tender but moble Neuro: wnl
Wbc: 3.8 with 30% bands Hct: 43 Plts:129 Bili: 3.6 AST: 370 ALT: 251 Alk Phos: wnl Creat 1.8 INR: 2.2 FDP 5<20
Vasculitis Lupus Polymyositis/
dermatomyositis TTP JRA Wegener’s
Atypical rash Hot joints Non-tender muscles No lung involvement Clear CXR No pupura Positive FDP, INR
Sepsis ABE HIV seroconversion TSS Staph TSS Gp A Strep
No conj hemorrhages, murmur, splinter hemorrhages
No risk factors
Rheumatic Fever overlap TSS Usually 4-6 weeks post GAS sore throat Rare USA, but kills millions annually in 3rd
world Associated with a specific M protein type
Recent evidence of Gp A strep
Culture, ASO, streptozyme
Major Manifestations: Carditis 40% Polyarthritis 75% Erythema marginatum
<10% Subcutaneous nodules
<10% Choreaform
movements 15%
Minor Manifestations: Fever Arthralgia Heart block Elevated acute phase
reactants
Joint Involvement: Arthralgia to arthritis Inverse relationship between severity of joints
and severity of carditis Usually knees, elbows, ankles, wrists
Subcutaneous nodules: Firm, painless over tendos Associated with carditis and occur weeks later
Painless, mobile, macular erythema on trunk and extremities
Fever Lightheadedness/Hypotension GI distress Hematologic ABNL Rash No other cause identified Hepatitis OK, but Arthropathy unusual Moving rash is not typical
May occur 6 months later Emotional lability Generalized weakness Rapid uncoordinated purposeless
movements Self limited
Penicillin Salicylates Steroids
High Risk Recurrence IM PCN monthly Oral PCN 250 mg BID or Sulfadiazine 1 Gm Tx 5 years or until age 18: whichever is
LONGER Check household contacts