Young Girl With Swollen Wrists and Ankles

A previously healthy 14-month-old girl of East Asian descent presented with fever, cough, coryza, and reduced oral intake, accompanied by bilateral wrist and ankle swelling. Vital signs were within normal limits, except for a pulse rate of 120 beats/min and axillary temperature 38.2°C (100.8°F). Examination showed symmetrically tender and swollen wrists and ankles, with reduced passive and active range of motion. Initial abnormal laboratory results included ionized calcium 0.73 mmol/L(1.22 to 1.37), alkaline phosphatase 918 IU/L (151 to 342), and a positive rapid influenza A nasopharyngeal swab result.

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