[Migrant polyarthritis and EBV infection]

Area of Science:

• Pediatric Rheumatology
• Infectious Diseases
• Viral Pathogenesis

Background:

• Rheumatic fever is a significant concern in pediatric patients presenting with migratory polyarthralgia and fever.
• Elevated Anti-streptolysin O (ASO) titers are often indicative of streptococcal infection, leading to a presumptive diagnosis of rheumatic fever.

Observation:

• A 12-year-old boy presented with fever, pharyngitis, and acute migratory polyarthralgia.
• Initial investigations revealed an increasing ASO titer, prompting a diagnosis of rheumatic fever.
• Further examination showed splenomegaly and positive IgG and IgM antibodies against Epstein-Barr virus (EBV).

Findings:

• The clinical presentation and initial serological findings were consistent with acute EBV infection, not rheumatic fever.
• Polyarthritis was a prominent symptom of the EBV infection in this case.
• Splenomegaly was also noted as a clinical sign of EBV.

Implications:

• Epstein-Barr virus infection should be included in the differential diagnosis for pediatric patients presenting with migratory polyarthritis.
• This case highlights the importance of comprehensive serological testing in differentiating viral infections from autoimmune conditions.
• Accurate diagnosis of EBV is crucial for appropriate management and to avoid unnecessary treatments for conditions like rheumatic fever.