Polychondritis in a child

A 13-year-old boy was admitted to hospital with a low-grade fever (maximum temperature of 38°C) that had persisted for 6 months. During this time, his body temperature typically increased in the afternoon or evening and was accompanied by arthralgia, mild headache, and cough. The patient did not report any other clinical signs or symptoms. His white blood cell count, haemoglobin concentration, platelet count, C-reactive protein concentration, and erythrocyte sedimentation rate were all normal. No bacterial or fungal infections were detected in the blood, bone marrow, or cerebrospinal fluid cultures. Ultrasound examination revealed multiple enlarged lymph nodes in the neck, bilateral subclavian region, abdominal cavity, and groin. The patient had previously been treated with piperacillin-tazobactam and aciclovir, but showed no improvement. His past medical history and family history were unremarkable.