Impaired renal function and fever of unknown origin in a patient with pediatric granulomatous arthritis: Questions

Excerpt

An 8-year-old female presented with bilateral posterior uveitis, polyarthritis, and synovial cysts on the right wrist since the age of 2. She was diagnosed with juvenile idiopathic arthritis (JIA) and treated with methotrexate and prednisolone. Granulomatous uveitis was detected during ophthalmologic routine. Considering the characteristics of the uveitis in association with the articular involvement, pediatric granulomatous arthritis (PGA) was suspected. Mutation in the NOD2/CARD15 gene confirmed this diagnosis. Ocular inactivity was achieved with topical and systemic corticosteroids, with no need to initiate new immunosuppressant therapy besides methotrexate. Six months after beginning the follow-up, she presented with fever of unknown origin and further investigation was initiated. Without physician’s consent, the caregiver administered ibuprofen daily during 2 months in order to control the fever. Abdominal ultrasonography revealed hypoechogenic nodular formation with a regular contour in the right adrenal gland. Nuclear magnetic resonance imaging of the abdomen showed nonspecific nodule of 2.1 × 1.7 cm in the right adrenal gland and discrete retroperitoneal adenomegaly. …