A 13 yr Male with Redness of eyes,Fever, Burning micturition and swelling of cheeks

A 13yr old male  who is student brought by parents with complaints of
Redness of eyes since the 5days
Fever since 4days
Burning micturition since 4days 

History of present Illness:
Patient was apparently asymptomatic 5days back after which he developed Redness of eyes,followed by Fever which is high grade  insidious onset, gradually progressive associated with burning micturition.
H/o yellowish discoloration of eyes 3days
H/o swelling in both cheeks since 2days 
H/o pain and difficulty in flexing left knee since 2days associated with progressive swelling
No H/o recent travel 
No H/o  similar complaints in the past 

PAST HISTORY 
N/k/c/o DM, Hypertension,  TB, Epilepsy,CVD, Asthama,Thyroid disorders

PERSONAL HISTORY

Single
Student
Diet :Mixed
Appetite: Lost
Sleep: adequate
Bowel and bladder regular
Addictions No 
No known Allergies 

GENERAL EXAMINATION

Pt is conscious coherent and cooperative 
Icterus present
No  pallor, cyanosis, clubbing generalized lymphadenopathy, edema 

Vitals

Temp: 101F
Bp :110/70 mm Hg 
PR :100 bpm 
RR: 18cpm
SpO2 : 98%
GRBS: 110mg/dl

SYSTEMIC EXAMINATION 

Cardiovascular system ::
No thrills 
S1,S2 are heard
No Murmurs 

Respiratory system::
No Dyspnea
No wheeze
Location of trachea :Central
Normal vesicular breath sounds
No adventitious sounds.

Abdomen ::
Shape of Abdomen -Schaphoid
No tenderness, palpable mass,
Normal hernial orifice
No bruits, free fluid 
No organomegaly 
Bowel sounds present.

CNS::
No focal neurological deficit 
GAIT: Limping Gait
Right eye 
left eyeleft cheek

Investigations::
X ray Hip
x ray Right  thighx ray left thighChest X ray 
Xay left knee jointUltrasound:-2D ECHO
ECG on 2/7/2024ECG on  3/7/24

Hemogram,RFT, LFT, ESR,CRP, Aptt,PT, INR,CT,Bt . Dengue,widal test, malaria 
ASO titres: 311IU/ml
 PROVISIONAL DIAGNOSIS::- -
Acute febrile Illness
?Acute Rheumatic fever 
?Mumps
?Leptospira


Treatment:-
1.Iv fluids .9 Ns ,RL @ 50ml /hr with optineuron
2.Inj.Ceftriaxone 1gm/IV/Bd
3.Inj.Doxycyclline 100mg/IV/Bd
4.Inj.Pan 40mg Iv/OD
5.Inj.Pcm 500mg IV/Stat
6.tab .Pcm 500mg /po/Tid 

Problems list::-

Sub-conjunctival haemorrhages
Fever
Throat pain
Burning micturation
Parotid swelling
Cervical lymphadenopathy
Left knee pain followed by left inter-phalangeal joint pain.

CUE-normal
ASO titires raised (311.7IU/ml)
Raised ESR and positive CRP

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