HIV in Children
Arthritis in an HIV infected child
Ira Shah
Professor and Head, Pediatric Infectious Diseases and Pediatric Gastroenterology, B J Wadia Hospital for Children, Mumbai, India.
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India.

An 8 years old HIV infected boy on antiretroviral therapy (ART) for the past 3 years presented with fever and left hip pain for 15 days. There was no trauma or rash. Grandmother had tuberculosis (TB) 3 years ago. The child was given some oral medications but there has been no relief. He had a similar episode 2 years ago involving same hip joint with restriction of joint movements which resolved on its own. For present complaints, MRI spine was done which was normal. RA factor was negative. Mantoux test was positive. The child was started on antituberculous therapy (ATT) by an orthopedic surgeon on clinical suspicion of tuberculous hip effusion. On examination, the child was febrile, had tenderness over left hip and restricted movement of left hip with pain and restriction of movements on flexion of both shoulders, the small joints of the hand and bilateral knees. He was unable to stand or sit up. Other systems were normal. He also had a restriction of movement of the cervical spine and restricted TM joint involvement.

Is this tuberculous arthropathy?
See Previous Teaching Files
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Infection in Children - Part 2

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