{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:59:48Z","timestamp":1753887588354,"version":"3.41.2"},"reference-count":45,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:p>An 8-year-old boy with asthma presented with prolonged fever, malaise, extremity weakness, polyarthralgias, malar rash, and subcutaneous nodules. Physical examination was remarkable for a faint malar rash, flesh-colored papules on the dorsal aspect of the fingers, arthritis of multiple joints in the hands, and subcutaneous nodules. The nodules were firm, nontender, and distributed over multiple extremities and the trunk. The patient was admitted to expedite workup. Initial laboratory test results revealed leukopenia, mild elevation of the aminotransferases, an elevated erythrocyte sedimentation rate, and normal level of creatine kinase. His echocardiogram was normal. Infectious disease studies were negative. Additional examination revealed dilated capillaries in his nail beds and bilateral hip weakness. MRI of his extremities was negative for myositis or calcification of the nodules. We obtained a biopsy of the subcutaneous nodules, and because the patient remained afebrile during the hospitalization, we discharged him from the hospital with outpatient follow-up. Our expert panel reviews the course of the patient\u2019s evaluation and investigation, as well as the implications of his diagnosis based on the tissue pathology from the nodule biopsy.<\/jats:p>","DOI":"10.1542\/peds.2021-052974","type":"journal-article","created":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T08:06:42Z","timestamp":1649318802000},"source":"Crossref","is-referenced-by-count":0,"title":["An 8-Year-Old Boy With Prolonged Fever and Subcutaneous Nodules"],"prefix":"10.1542","volume":"149","author":[{"given":"Deepak","family":"Gupta","sequence":"first","affiliation":[{"name":"aDepartment of Pediatrics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lior","family":"Goldberg","sequence":"additional","affiliation":[{"name":"bCancer and Blood Disease Institute"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aileen","family":"Dickinson","sequence":"additional","affiliation":[{"name":"cDivisions of Rheumatology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan","family":"Hughes","sequence":"additional","affiliation":[{"name":"dDermatology"},{"name":"gDepartment of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikram","family":"Anand","sequence":"additional","affiliation":[{"name":"eInfectious Diseases"},{"name":"gDepartment of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Stokke","sequence":"additional","affiliation":[{"name":"bCancer and Blood Disease Institute"},{"name":"gDepartment of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark H.","family":"Corden","sequence":"additional","affiliation":[{"name":"fHospital Medicine, Department of Pediatrics, Children\u2019s Hospital Los Angeles"},{"name":"gDepartment of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2022,4,7]]},"reference":[{"issue":"9","key":"2023110213511072300_B1","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1542\/pir.36.9.380","article-title":"Pediatric Fever of Unknown Origin","volume":"36","author":"Antoon","year":"2015","journal-title":"Pediatr Rev"},{"issue":"1","key":"2023110213511072300_B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/cid\/ciaa1215","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease","volume":"72","author":"Lantos","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023110213511072300_B3","first-page":"11","volume-title":"Annual Morbidity and Special Studies Report 2017","author":"Balter","year":"2017"},{"issue":"1","key":"2023110213511072300_B4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12941-020-00364-0","article-title":"Presence of Borrelia miyamotoi infection in a highly endemic area of Lyme disease","volume":"19","author":"Marcos","year":"2020","journal-title":"Ann Clin Microbiol Antimicrob"},{"issue":"1","key":"2023110213511072300_B5","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.rdc.2009.03.004","article-title":"Parvovirus B19: its role in chronic arthritis","volume":"35","author":"Colmegna","year":"2009","journal-title":"Rheum Dis Clin North Am"},{"issue":"6","key":"2023110213511072300_B6","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/S0025-7125(16)30498-9","article-title":"Sexually transmitted arthritis syndromes","volume":"74","author":"Keat","year":"1990","journal-title":"Med Clin North Am"},{"issue":"4","key":"2023110213511072300_B7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/RHU.0000000000000396","article-title":"Chikungunya virus disease: an emerging challenge for the rheumatologist","volume":"22","author":"Vijayan","year":"2016","journal-title":"J Clin Rheumatol"},{"key":"2023110213511072300_B8","unstructured":"Centers for Disease Control and Prevention\n          . 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