6yo joint pain + rash on legs

[ImpYCelyn]

Weird one.

DS1 (6) complained yesterday of a sore knee at bedtime. He said it had hurt "a bit" since morning, but he'd been playing fine so I assumed delaying tactic. This morning he said it hurt worse, but he seemed okay and I just ignored it... I picked him up from school and he was limping, but also crying about how much it hurt. The teacher didn't mention he'd had problems during the day, so I thought it might just be a bid for TV time. BUT, when I was reading with him I noticed he now has a rash on his legs, pinprick spots. When I tried to take off his socks to see it better, he literally screamed when I did the one on the other leg, and said his ankle really hurt. A much better look shows that his knee does look a bit swollen over the kneecap it didn't this morning, but I still feel like a terrible parent, and the rash is on his bum, the backs of his thighs, and both sides of his lower legs. Not feet, and no higher. He needed the loo and I went to phone the gp for advice and I had to step into garden for phone signal, when I opened the door I could hear him sobbing from the pain of putting weight on the ankle. He now can't straighten his knee fully. He sobs if I try too (which I was doing to try to compare the size of the them).

On Friday I took him to the gp because he said it hurt when he wee and he claimed to have had red wee, although I never saw it. GP did urine dip and said he was fine. On Saturday he had a tummy ache, headache and a bit of a temp. He slept til 11am on Sunday after a late night, but perked up and was fine Sunday afternoon and Monday. And then nothing until a bit of knee pain yesterday evening. Now this.

He doesn't tend to overact illness or pain, he prefers the credit of being brave, and the only time I've seen him like this before was the day he broke his arm. 24 hours late I had to drag him out of a tree with a plaster cast... so I'm inclined to believe him. But it seems rapidly escalating and the rash is weird.

He's had a dose of neurofen and is quiet with both legs up. But moving them or putting weight in them sets him off again.

Any ideas?

[MrsKCastle]

I don't know about the rash, but with the knee and ankle pain I would try to get him seen today I think. DD1 had a nasty joint infection as a toddler which needed hospital treatment. Is your GP still open or is there a walk-in centre near you?

[Polly99]

I'd skip the GP and go to a hospital walk in centre or A&E in the morning as a GP won't have a clue if it is septic arthritis. My DD had it too when she was very little, and it took blood tests etc to diagnose. Like your son she had a fever a few days before it kicked off (no rash though).

[spiney]

Sorry to hear about your boy.

I'm not suggesting I can give you any sort of diagnosis but eighteen months ago I had the following symptoms:
Fever and aching followed by a red rash on my legs ( at which point I went to Casualty) followed by awful joint paint. It was diagnosed as Erythema Nodosum.

It was diagnosed with a blood test and ruling out other things. Casualty was the right thing to do as the rash came on quite suddenly.

I hope you get this sorted out.

[Wandastartup]

Sounds like HSP often a reaction to an infection but could be other things, he needs seeing today

[HallowedMimic]

Obviously you'll have to see a doctor, but what's his diet like?

It's fantastically uncommon these days, but chronic vitamin C deficiency can present like that.

[1AnnoyingOrange]

Sounds like HSP, don't panic but suggest you take him to see GP tomorrow.

www.nhs.uk/conditions/henoch-schonlein-purpura/Pages/Introduction.aspx

[BurnTheBlackSuit]

I don't know, but the rash and pain would make me think that you should probably do something today- call 111?

Don't blame yourself for not listening to him before though- it's very hard to know the difference between minor and not so minor injuries in children. So many of us have not recognised broken bones at first.

[Iambubbles86]

HSP. My 6 year old is just getting over it. There is a Facebook support group that is useful. Your some will need to have weekly blood pressure checks and urine dips as it can be associated with kidney problems but its less common in under 8s. Message me if you want any more info or advice

[beautifulgirls]

Another vote for HSP - my youngest had this 18 months ago and is doing fine now. You do need to get checks done and have kidneys monitored if it is HSP.

[nocoolnamesleft]

Also suspect HSP. Great news that the initial urine dip was normal, but still needs seeing and checking out properly.

[ImpYCelyn]

Apologies for not replying to these. After another bout of hysterical sobbing I took him to the urgent care unit at the hospital, but managed to leave my phone at home. DH has just relayed me as DS1 is still there with suspected HSP and waiting on blood tests. I feel like the worst parent-

In the time we were there the rash has become very nasty, the two already swollen joints now barely move, and other knee and ankle have started swelling! I'm sure it could have waited for the GP tomorrow, but I'd be in a total panic by now if he wasn't already in hospital!

I'm going to feed the baby and go to bed, but thank you for the info re Facebook etc, and I'll definitely be doing PM tomorrow! Thank you all so much!!

[Polly99]

Glad he's being seen OP. I'd never heard of HSP before yesterday (MN is very educational!). I hope he is feeling better very soon.

[Iambubbles86]

Its supposedly quite a rare autoimmune illness Polly (14 cases per 100,000) but everywhere I've looked I've come across anecdotes that there has been an unusual increase of instances of it this year. It normally comes about a week after a viral upper respiratory infection although other things such as medicine allergies/chicken pox have been noted as possible causes. Main symptoms are the rash, joint pain and swelling and gastric symptoms (pain. Diarrhea. Blood in stools). It can happen at any age but is more common in children, there appears to be a tenuous genetic link too, its not cpntageous but if one child has had it, siblings are marginally more likely to also get it. Urine is tested for proteins and blood weekly, if you can make it to 12 weeks without nephrotic range proteinuria then you are generally thought to have recovered although tests will still continue for a year due to rare cases PR it reccuring after that

[pieceofpurplesky]

Hope all is ok OP

[ImpYCelyn]

Thanks all, he's home and feeling a bit better. Definitely HSP. His blood results looked okay, although they're being sent away to be checked, so the paed thinks he shouldn't get it too badly. Although they did warn us he will probably get worse before he gets better... Lots of snuggles with his baby brother at the moment.

I'm dreading the school run later though. I have to pick up DS2 from reception and short of putting DS1 in the pram and carrying the baby I'm not sure how I'll manage it...

[Iambubbles86]

Have you got a neighbour or friend who could sit with D's while you do the pick up?

The rash dissapeared after a week with my ds and were now at 13 weeks post diagnosis today and he's had no complications or recurrances. One thing to be aware of is to make sure you keep Ds hydrated as my sons urine kept showing as having protein in it but it turned out to be false as he's a massively sweaty sleeper and highly concentrated first morning urine can show up as protein on a dipstick and send everyone into a flap when actually its nothing to worry about.

[ImpYCelyn]

Another mum has volunteered to pick up DS2, and there's a dad I'm going to ask about drop off tomorrow.

How long was your DS off school? He doesn't seem to be in too much pain, but he is just sitting there with his legs up, he says it hurts once he's standing. One knee and one ankle are still very swollen.

Good reminder about drinking, DS1 sweats like crazy over night too!

No sign of stomach pains or gastro symptoms. I'm unclear on whether he might have missed them entirely, or whether I should expect them...

Thanks very much bubbles 😊

[ImpYCelyn]

I find it so strange right now that I'll be worrying about this for the next few months. It's weird to get my head round the future testing for complications.

Great news that your DS is looking clear!!

[Undies1990]

Hi. My daughter had HSP a few years ago which was caused by an un-diagnosed bacterial throat infection. The body tries to fight the infection but if left, the immune system starts malfunctioning which causes the HSP symptoms. Has your child been unwell recently; has a doctor looked into what caused the HSP? My daughter had to undergo regular blood and urine tests for 12 months after her HSP diagnosis - she's all well now but has been left with skin discolouration around her ankles unfortunately.

[ImpYCelyn]

Hi undies, I don't think they're specifically looking for the cause, he was mildly "under the weather" at the weekend, so I think they're just assuming he had a mild virus then. But his blood tests are going off for further study.

Glad to hear your DD is better! Sorry to hear about her ankles though

[Iambubbles86]

D's was diagnosed the Friday before half term and went back after half term. We were lucky, he had a very mild case, his only symptom was rash, no gastric issues,
no kidney issue, and 1 instance of high blood pressure. If you can tell me ds1 height and weight I can give you a rough idea what his bp should be.

I'll be perfectly honest with you, I had a breakdown after ds's diagnosis,I was on my way to one anyway but this was he straw that broke the camels back. I have ocd and I researched waaaay too much, if I can give you one piece of advice its trust the doctors and remember that whilst you can find horror stories on the net that's because the majority of people who have this is goes away without any real issues so they arnt the people who write on the internet about it. Like I said, the facebook group are helpful, but it comprises mostly of a small minority who have it long term mainly, they are very knowledgeable about treatment etc but do not represent the majority of people who develop HSP.

[ImpYCelyn]

I think he's about 118cm and 23kg.

I'm hoping he's got a mild case. After resting all day he been able to limp about a bit this evening. Although was in pain again before bed. Still swollen though.

Sorry to hear that! I have OCD (particularly on the O side) too and bizarrely, until last night, would have said I was careening into another dose of post natal anxiety. Everything was getting very hard to handle (various things all mounting up at once and out of control). But 6 hours in a and e with DS1 has left me feeling very calm. Will see if it lasts. But I really sympathise, especially with the over researching. I hope you're feeling much better now

[Iambubbles86]

OK, anything below 111/71 is normal. Between that and 127/88 is high but not a massive concern as long as its not on consecutive measurements. Bear In Mind kids who have never had their blood pressure taken before will likely show on the high end of the scale the first few times. For example my 3 year old had his checked a few weeks ago for a separate matter and his was 111/90. Also make sure he stays calm and rested at least 20 mins before the checks, his bladder needs to be empty and he shouldn't have eaten for at least an hour. If he's just eaten, needs a wee, is excited or has been active they can all cause false high blood pressure readings.

The vast majority of children recover quickly, once the rash has disappeared recurrence is less likely and after 4-6 weeks the majority are fine. After 12 weeks the chance of kidney issues falls to 2%.

I was calm at first, I always am in an immediate crisis, it's after the initial urgency is over that I tend to spiral, I started to decline about 2 weeks after diagnosis. I became obsessed with checking his urine on a dipstick every morning, it then extended to checking his heart rate and oxygen levels (I bought an oximeter, bear in mind heart rate and oxygen has no relevance to HSP), I then started taking his temperature multiple times a day -also no relevance to HSP. The go who was doing Ds checks noted how anxious I was as did the nurse, ended up on fluoxetine 40mg and having councilling and I am doing so much better. If you do ever need to talk I'm here though as there arnt that many of us around who have been through it (compared to more common childhood illness like chickenpox etc). Thinking of u all and hoping D's feels better really soon

[ImpYCelyn]

Oh bubbles, that sounds awful for you! I was on diazepam about 2 years/18 months ago as I got myself really worked up because DS2 kept getting viruses (really badly, really frequently) and DN has leukaemia, and while I knew there was no family link and it was highly unlikely to be that, his immune system was so rubbish I just panicked. I couldn't stop. I referred myself for counselling as well. It helped so much. I'm really glad you're doing better! OCD I think gets written off as being germphobic, but it's so much more and can be an absolute nightmare when it gets out of control!

Thank you for the info. The gp surgery called to say they've ordered a paediatric blood pressure cuff which should arrive Monday and then they'll book him in for a check up. I'll factor all that in. I remember about "white coat hypertension" but had forgotten about need a wee etc.

Well foolishly I was feeling positive today as although he had a terrible headache during the night, and foot pain this morning, the swelling was going down and he was hopping about okay and his appetite was better. But he's just woken up from a nap and when I took the blanket off he's erupted in tiny pinpricks again (as well as the previous bigger blobs) so I'm expecting a much worse rash flare up. He's also comparing that his elbow hurts, but I thought it was mainly lower limb pain, so maybe that's a coincidence...

I've been cheering myself up with retail therapy (I feel like I'm going a bit mental, I've got two weeks left of maternity leave and me and the baby are now stuck indoors all day, when normally we're out for hours. I know it's only been two days, but still. I feel cooped up very easily). So I've been on Smiggle buying bits for the boys for next academic year and for my nieces in France. I think I'm going to give DS1 some bits to cheer him up when they arrive, he's doing such a good job of staying cheery, even though he was upset about the new spots. Plus DH is now getting more for his birthday than he would have before this week. Whoops.

[Iambubbles86]

As far as I'm aware subsequent rashes are normally milder than the initial presentation. The most common swelling is ankles, knees and wrist but ears and facial swelling are reasonably common too so id imagine elbow could be.

You're coping amazing and I bet ds and dh will love their extra presents.