The Link - February 2026

Persistent fever without a clear source is one of the most challenging presentations in pediatrics. For some children, this fever represents systemic juvenile idiopathic arthritis (sJIA), a diagnosis that is frequently delayed because arthritis may be absent at onset. Early recognition by general pediatricians is critical, as prompt treatment can alter disease trajectory and reduce life-threatening complications.

Juvenile idiopathic arthritis (JIA) is defined as chronic arthritis beginning before age 16 and lasting at least six weeks. Systemic JIA accounts for approximately 5% to 20% of JIA cases and differs fundamentally from other subtypes in both immunopathology and clinical course. Rather than a classic autoimmune disease, sJIA is now understood as an autoinflammatory disorder driven by dysregulation of the innate immune system and excessive cytokine production, particularly interleukin (IL)-1 and IL-18.

Tic disorders, including Tourette syndrome (TS), are common childhood neurodevelopmental conditions. Tics are sudden, rapid, recurrent, nonrhythmic movements or vocalizations. When multiple motor tics and at least one vocal tic persist for more than a year, the diagnosis meets criteria for TS. TS typically emerges between ages 4 and 6 and peaks in preadolescence. Most children develop simple motor tics, such as eye blinking or facial grimacing, that often spread from the face and head to the shoulders and limbs. The tics become more complex over time. Vocal tics usually begin one to two years later with simple sounds such as throat clearing or sniffing that may progress to words or phrases. Around age 10, many children report premonitory urges, which are brief sensations relieved by performing the tic.

Tics characteristically wax and wane, and tend to worsen with stress, anxiety, emotional excitement and fatigue, and lessen during focused, goal‑directed activities such as sports or music. It is helpful to explain to teachers that tics are not volitional misbehavior, even if children can sometimes postpone them.

The hit television series The Pitt depicts the lives of health care professionals in a Pittsburgh trauma center’s emergency department in “real time” over the course of one shift. The show has received critical acclaim, winning five Emmy Awards in its first season. It has also garnered popular attention, averaging 10 million viewers per episode in season one with even higher numbers anticipated in season two. Many laud the series for its realism, and I have heard more than one colleague has claimed it the “most realistic medical show ever.”

A 6-year-old boy presents for evaluation of light-colored patches on the skin. Approximately one year ago, his parents noticed a lighter patch on the left side of his neck as well as a similar area behind his knee. The lesion behind the knee has since resolved, but the patch on the left neck has persisted. The lesion has remained stable in size since it was first noticed.

The family is not applying any topical agents to the area. Family history is notable for the patient’s father having similar lighter patches on his skin, but he has not received a diagnosis. There are no associated symptoms, including pruritus or pain, and the family denies a preceding rash.

The patient is otherwise healthy and growing well. Review of systems is negative for fatigue, weight changes, temperature intolerance, headaches, gastrointestinal symptoms, or changes in sleep or energy.