Acute group A streptococcal infections and sequelae (pediatrics) Quiz: Ace Your Exams
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A 10-year-old girl presents to the pediatric clinic for evaluation of fever and joint pain involving her knees and elbows. Her mother mentions the patient had a sore throat with fever 3 weeks ago, which resolved without any treatment after about a week. Temperature is 38.3°C (101°F), pulse is 115/min, respiratory rate is 16/min, blood pressure is 114/74 mm Hg, and oxygen saturation is 99% on room air. Skin examination reveals blanching erythematous macules on the trunk and extremities. Multiple small firm nodules are palpated over the bilateral elbows. Cardiac exam reveals a 2/6 systolic murmur heard at the apex and radiating to the left axilla. There is tenderness to palpation and pain with range of motion and swelling over the knees, elbows and wrists bilaterally Rapid strep antigen testing is negative. Laboratory results are shown below. Which of the following is the best next step in management?
| Laboratory value | Result |
| Serum chemistry | |
| Sodium | 144 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 95 mEq/L |
| Creatinine | 0.9 mg/dL |
| Erythrocyte sedimentation rate (ESR) | 55 mm/hr |
| C-reactive protein | 25 mg/L |
| Anti-streptolysin (ASO) | Positive |
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