Hello,
Thank you for your query at DoctorSpring.com
I can understand your situation. As per your description, she has been ill for more than 7 days now.
The information that you have provided is very sketchy and does not convey much..
Kindly mention her age and provide her symptom chronology in detail. You need to tell me how it started, what came first, description of fever and evolution of joint pain in detail. You need to provide your city of residence as well as her past and family history.
Do attach a copy of all her reports and blood work till date.
Only then would I be able to genuinely help you.
Regards
Dr. Saptharishi L G
Dr. Saptharishi L G
Patient replied :
My daughter is 16, it started approximately 3 weeks ago she was not feeling well, felt like vomitting and began getting sore muscles and
and feverish, doctor ran blood results and had bilirubin levels of 3.6, ast levels of 566 and alt of 890 urine was dark yellow and her lipid panel was
cholesterol 177 which was high
hdl 23 was low
cholesterol/hdl ration was 7.7 high
and ldl 129 all other numbers in range
we are from staten island new york
one week later we went to emergeny room and the same tests were run as she had trouble walking and complained difficult to breathe
white blood cell count 6.61
bilirubin 1.2
alkaline 47
aspartante 188
alanine 290
monoctyes were 13.8
mono number .91
all other numbers were in range.she was taking the drug minocycline for acne prior to this outbreak she is severly ill and had trouble walking last night her feet, fingers and shoulders are in pain and she felt a sore throat
please let me know if this is enough information
regards
eleanor wren
Dear Eleanor,
Really glad that you gave me all the above information. It has opened up a wide variety of clinical possibilities.
These symptoms could fit into a viral hepatitis like picture, but on closer scrutiny, I have a definitive suspicion of MINOCYCLINE-induced side effects.
I am not sure if any doctor has already spoken to you about this. Minocycline can cause hepatitis like presentation; can cause hepatotoxicity as well as muscle and joint pains. Such reports are all over medical literature. There is plenty of evidence reporting similar symptoms with minocycline use. So my first question is- HAS SHE STOPPED TAKING MINOCYCLINE? IS SHE STILL ON THE DRUG?
If it is minocycline-induced, we need to stop the drug right away.
If it is a viral induced hepatitic illness, the child gets better as the liver enzymes (ALT/AST) start falling. It is unlikely that child would develop joint pains in a hepatitis illness (very rare indeed) especially during the phase of recovery. It has been described in diseases such as dengue, chikungunya, etc But these diseases are rare in temperate climatic zones.
Will give you further advice once this minocycline issue is clarified.
Regards.
Patient replied :
hello doctor
she has stopped the minocycline approximately 3 weeks ago when the illness began
her liver enzymes have dropped as per my last updated numbers but she still is in terrible joint/and muscle pain that is travelling this morning it was feet again and then sharp elbow pain that went away. her throat was hurting her yesterday and she is very tired and sleepy
she went for fresh blood tests yesterday but will not have those results yet.
regards,
eleanor wren
Dear Eleanor,
Thank you for the above clarification.
Stopping the drug was an appropriate decision in my view. But, the fact that she is developing new symptoms three weeks after stopping the drug is a pointer against a drug induced side effect.
Does she have any joint swelling or redness or warmth over the joints?
Does she have any burning sensation while passing urine?
Has she had similar episodes of joint pain and sore throat in the past?
Where do you live? Is rheumatic fever common in your region?
You need to get the following tests done..
1. Anti-streptolysin-O (ASO) titres
2. C-reactive protein
3. Rheumatoid factor
4. Dengue serology
5. Hep A/ Hep B/ Hep C testing
6. Urine routine/ microscopic examination and culture
7. Serology for dengue, rickettsial infections, chikungunya, leptospirosis, etc (after a discussion with your local physician, depending on the prevalence of these infections in your region)
As of now, please start her on adequate analgesics (pain-relievers). If she is already on them, increase the dose or add another drug. You can consider using a combination of these two drugs to relieve her pain:
1. Tab NAPROXEN 250 mg twice daily (you can use a gastro-resistant preparation/ extended release preparation)
2. Tab PARACETAMOL 500 mg thrice daily.
Further decision making would depend on a thorough clinical examination and suggested laboratory testing. So, I suggest that you talk to your physician about the above tests.
Hoping that your daughter recovers soon.
Patient replied :
hi doctor,
i should clarify the joint paint/muscle pain has been happening since the beginning three weeks ago along with the elevated liver enzymes..
Does she have any joint swelling or redness or warmth over the joints? no
Does she have any burning sensation while passing urine? no
Has she had similar episodes of joint pain and sore throat in the past? no
Where do you live? Is rheumatic fever common in your region? we live in new york city
i will ensure i have our doctor test for the below tests the hepatitis came back negative that was done already
You need to get the following tests done..
1. Anti-streptolysin-O (ASO) titres
2. C-reactive protein
3. Rheumatoid factor
4. Dengue serology
5. Hep A/ Hep B/ Hep C testing
6. Urine routine/ microscopic examination and culture
7. Serology for dengue, rickettsial infections, chikungunya, leptospirosis, etc (after a discussion with your local physician, depending on the prevalence of these infections in your region)
are the following drugs over the counter?
1. Tab NAPROXEN 250 mg twice daily (you can use a gastro-resistant preparation/ extended release preparation)
2. Tab PARACETAMOL 500 mg thrice daily.
thank you
eleanor wren
Dear Eleanor,
Thank you for the clarification.
If her joint pain/muscle pain has been there since there three weeks, then all this could be explained as a side effect of MINOCYCLINE. If that is the diagnosis, then the treatment is only supportive. We would have to wait for the symptoms to improve and treat her pain with analgesics.
However, since there is no way to confirm the diagnosis of 'minocycline side effect' now, we would have to go ahead and rule out other infectious conditions even though they seem unlikely. Infectious diseases are rare because fever has not been prominent. Again infectious inflammation of the joints would be accompanied by redness, swelling, etc. Reactive arthritis asssociated with a urinary tract infection could present this way, but it appears to be unlikely as she has no urinary symptoms.
New York city residence decreases the possibility of dengue, chikungunya, rickettsia or leptospirosis. They are uncommon in the US. Keeping this in mind, it may not be necessary to get tested for the above tropical infections. But please do get the other tests done. It is only to rule out the conditions that can present in a similar manner.
And Yes, both these medicines are available as over-the-counter medications in US (as per FDA regulations).
Regards.