Image: This young man spent a week in Fiji in 2003 and on returning to Canada  immediately developed generalized myalgias and fatigue without fever for 4 days followed by 2-3 days of bilateral inguinal discomfort with tender lymph nodes, and some scattered pink macules. Seven days into this illness he developed pain and swelling in his right ankle and lesser pain without swelling in both knees and an elbow. The ankle rapidly improved over 5 days with very minimal recurrent discomfort over several months. He had no history of joint problems. His WBC, RA, ANA and uric acid were normal. The diagnosis was:.

Day 7 of illness...tender, painful, warm, swollen and pink

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Image 29. The diagnosis is Ross River Virus disease (formerly epidemic polyarthritis): the combination of fatigue, arthritis and rash were the clues. The Ross River Virus IgM was positive, an the plaque reduction neutralization test (PRNT) converted from negative to positive at the CDC Atlanta. This virus is a mosquito borne (arbovirus) virus in the family Togaviridae. There have been many cases in Australia this year.  (Harley D et al: Clin Micro Rev 14:909-932, 2001)