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Reply to Comment 1
The Child reported in our case had history of arthritis since the past one year. Although, large joints were affected as pointed out, the chronic history made a diagnosis of rheumatic fever unlikely. Also, there was no tachycardia and cardiac examination was clinically normal. Therefore, investigations for rheumatic fever and detailed cardiac evaluation were not considered necessary. There was some response to treatment with anti-inflammatory agents in our patient, but it took two weeks and was incomplete unlike what is expected with rheumatic arthritis.
Reply to Comment 2
We agree that in view of a diagnosis of HIV infection, CD4 T cell count should have been done to determine the severity of immunocompromise and plan further management. However, CD4 T cell count estimation is not done at our hospital. The parents were unable to do expensive investigations from elsewhere. Also, the child was lost to further follow up. Investigations like ANA, double stranded DNA, RA factor were done initially on presentation, before a diagnosis of HIV infection was made, to rule out other causes of chronic arthropathy.(Ahuja Sanjeev R)
Reply to Comment 1
The Child reported in our case had history of arthritis since the past one year. Although, large joints were affected as pointed out, the chronic history made a diagnosis of rheumatic fever unlikely. Also, there was no tachycardia and cardiac examination was clinically normal. Therefore, investigations for rheumatic fever and detailed cardiac evaluation were not considered necessary. There was some response to treatment with anti-inflammatory agents in our patient, but it took two weeks and was incomplete unlike what is expected with rheumatic arthritis.
Reply to Comment 2
We agree that in view of a diagnosis of HIV infection, CD4 T cell count should have been done to determine the severity of immunocompromise and plan further management. However, CD4 T cell count estimation is not done at our hospital. The parents were unable to do expensive investigations from elsewhere. Also, the child was lost to further follow up. Investigations like ANA, double stranded DNA, RA factor were done initially on presentation, before a diagnosis of HIV infection was made, to rule out other causes of chronic arthropathy.(Ahuja Sanjeev R)