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byarsfive

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  1. This is a very common but sorely under-recognized finding post-strep - in NJ we had an epidemic of acute post-streptocoocal enthesopathy over the past two years. Almost invariably involving bilateral knee and ankle joints with sufficient pain that many of these children refused to walk (and so neurology was called a lot). Everyone went from mild-severe-mild pain over the course of 1-3 days. Although this can possibly be viewed as a minor version of rheumatic fever (no fever, no rash, no heart involvement, just the rheumatic), it's different as that is usually over joints, and this is over tendons. There is almost nothing about this in the literature - so there's another paper to write Sigh. If others can confirm, this might be considered to be another strep warning sign to look out for .... Dr. T [/quot When this happened to him last year, it started in one achilles tendon and they booted him. After about 2 weeks in the boot (with no improvement) his other achilles went. That's when they started talking auto immune disorders, and ordering bloodwork. Nothing really showed up except that he had obvious inflammation. Ibuprofen around the clock didn't help either. He was booted on the other leg too, but eventually had to have a wheelchair because he felt pain even in the boots. After about a month total, it went away. Only to reappear right before we went to UCLA in the underside of his elbow (which lasted less than 24 hours) and then the next day in the tendon on his wrist, which also lasted less than a day. The only thing that troubled the UCLA pediatric rheumatologist with her "diagnosis" was that it lasted so long, because she said this type of reactive arthritis usually goes through fairly quickly. Well, here we are a year later, he just spent the last month fighting a sinus infection, strep and staph in the throat, and another sinus infection (4 different antibiotics). He finally feels better (last Tuesday), plays a couple of hours at the park with his buddies, and then his achilles starts bugging him. By the next day he can't walk on it at all, and now even in the boot (from last year) he has pain. Today the 2nd achilles goes down. I am not sure what to do for him. We are going to pediatrician tomorrow, so I guess we'll see what she says. Have you seen this type of tendonitis last so long in a post strep situation? Every one of the patients I dealt with were better in 2-4 days, it was like a script .... Because strep can be persistent, it's not inconcievable that it could last much longer, but what happened to your son may well be something different. Was he checked for HLA-B27? Dr. T I believe so..... is that the one for spondylitis? It sounds familiar, and it was negative, although I know it had something like a 20% false negative rate? Every blood test for any type of specific autoimmune disorder came back negative. When you say strep is persistent.... do you mean that maybe he still has strep in his system? Because that's what we thought last month when the sore throat went away, but then the sinus infection popped back up. The pediatrician thought that either staph, strep or both were lurking in the fluid in his sinuses. We did sinus rinses twice a day and it cleared out a ton of gunk, and then he seemed to finally get better (more energy, cough went away). They also did a nasal swab at that time, and it didn't show anything.
  2. This is a very common but sorely under-recognized finding post-strep - in NJ we had an epidemic of acute post-streptocoocal enthesopathy over the past two years. Almost invariably involving bilateral knee and ankle joints with sufficient pain that many of these children refused to walk (and so neurology was called a lot). Everyone went from mild-severe-mild pain over the course of 1-3 days. Although this can possibly be viewed as a minor version of rheumatic fever (no fever, no rash, no heart involvement, just the rheumatic), it's different as that is usually over joints, and this is over tendons. There is almost nothing about this in the literature - so there's another paper to write Sigh. If others can confirm, this might be considered to be another strep warning sign to look out for .... Dr. T When this happened to him last year, it started in one achilles tendon and they booted him. After about 2 weeks in the boot (with no improvement) his other achilles went. That's when they started talking auto immune disorders, and ordering bloodwork. Nothing really showed up except that he had obvious inflammation. Ibuprofen around the clock didn't help either. He was booted on the other leg too, but eventually had to have a wheelchair because he felt pain even in the boots. After about a month total, it went away. Only to reappear right before we went to UCLA in the underside of his elbow (which lasted less than 24 hours) and then the next day in the tendon on his wrist, which also lasted less than a day. The only thing that troubled the UCLA pediatric rheumatologist with her "diagnosis" was that it lasted so long, because she said this type of reactive arthritis usually goes through fairly quickly. Well, here we are a year later, he just spent the last month fighting a sinus infection, strep and staph in the throat, and another sinus infection (4 different antibiotics). He finally feels better (last Tuesday), plays a couple of hours at the park with his buddies, and then his achilles starts bugging him. By the next day he can't walk on it at all, and now even in the boot (from last year) he has pain. Today the 2nd achilles goes down. I am not sure what to do for him. We are going to pediatrician tomorrow, so I guess we'll see what she says. Have you seen this type of tendonitis last so long in a post strep situation?
  3. I am wondering if anyone has had a child who has had acute tendonitis after bouts of strep? My son has had this happen twice now, once last year and now again this week. He had strep prior both times. We saw a specialist at UCLA last year when it happened and her best guess was that it was a response to him having had strep a month prior to the tendonitis. This time, the tendonitis came on a few days after finishing the antibiotics for the strep. I inadvertently posted this on the wrong topic ADHD, so sorry for the multiple post.....
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