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2019, Number 2

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Rev Mex Pediatr 2019; 86 (2)

Juvenile idiopathic arthritis of systemic onset, a diagnostic challenge: Case report

Valencia-Palacio E, Uribe-Castrillón LM, Gallo-Sáenz CM, Zapata-Catellanos AL, Gallego-González D

Language: Spanish
References: 16
Page: 65-70
PDF size: 262.99 Kb.


ABSTRACT

Introduction: Juvenile idiopathic arthritis (JIA) is the leading cause of chronic arthritis in childhood; however, its diagnosis can be difficult. This article aims to describe the diagnostic process from a patient with systemic JIA. Case presentation: Male patient of 14 months of age, with 15 days of daily fever up to 40oC; the fever was refractory to antipyretic management and was associated with irritability and hyporexia. He received antimicrobials on suspicion of hidden bacteremia. Five days later, polymorphic erythema was added, so it was considered Kawasaki disease, receiving gammaglobulin but without clinical response. After 24 days of evolution, fever and arthritis persisted; Magnetic resonance imaging revealed intraarticular effusion in both knees and left hip, with no evidence of osteomyelitis. In synovial fluid of the right knee an increase of polymorphonuclear cells was detected, reason why septic arthritis was considered, initiating vancomycin. He was sent to another hospital because of the persistence of the condition; it was confirmed the fever and the maculopapular, generalized, not pruritic exanthema, which predominated on the trunk. Up to 40 days of evolution, the diagnosis of systemic JIA was confirmed and treatment with systemic steroids was initiated. One week later, tocilizumab and methotrexate were added because the symptoms remained unchanged. With this treatment the remission of fever and exanthema was achieved, as well as improvement of the joint symptoms. Conclusion: JIA is a disease that shares clinical signs and symptoms with different diseases. In general, due to the non-specific nature of the clinical picture and the lack of laboratory or imaging studies to confirm it, the diagnosis in young children is made by exclusion.


REFERENCES

  1. Abdwani R, Abdalla E, Al Abrawi S, Al-Zakwani I. Epidemiology of juvenile idiopathic arthritis in Oman. Pediatr Rheumatol Online J. 2015; 13: 33.

  2. Cimaz R, Von Scheven A, Hofer M. Systemic-onset juvenile idiopathic arthritis: the changing life of a rare disease. Swiss Med Wkly. 2012; 142: w13582.

  3. Minden K. Classification and epidemiology of juvenile idiopathic arthritis. Rheumatology. 2019; 106: 870-878. Available in: https://www-clinicalkey-es.consultaremota.upb.edu.co/#!/browse/book/3-s2.0-C20151013679

  4. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004.

  5. Kim KH, Kim DS. Juvenile idiopathic arthritis: diagnosis and differential diagnosis. Korean J Pediatr. 2010; 53(11): 931-935.

  6. Cassidy JT, Petty RE, Laxer RM, Lindsley CB (eds.). Systemic juvenile idiopathic arthritis. Textbook of pediatric Rheumatology, 6th ed. Philadelphia: Elsevier Saunders; 2011. p. 236-48.

  7. Modesto C, Antón J, Rodriguez B, Bou R, Arnal C, Ros J et al. Incidence and prevalence of juvenile idiopathic arthritis in Catalonia (Spain). Scand J Rheumatol. 2010; 39: 472-479.

  8. Solís SP. Artritis idiopática juvenil (AIJ). Servicio de Pediatría. Hospital Clínico Universitario de Valladolid. Pediatr Integral. 2013; XVII(1): 24-33.

  9. Singh S, Mehra S. Approach to Polyarthritis. Indian J Pediatr. 2010; 77: 1005-1010.

  10. Eraso R, Hernández L. Artritis idiopática juvenil. Pediatría al día, Tomo 2, SCP, 2017, pp. 223-247.

  11. Binstadt BA, Levine JC, Nigrovic PA, Gauvreau K, Dedeoglu F, Fuhlbrigge RC et al. Coronary artery dilation among patients presenting with systemic-onset juvenile idiopathic arthritis. Pediatrics. 2005; 116: e89-93.

  12. Dong S, Bout-Tabaku S, Texter K, Jaggi P. Diagnosis of systemic-onset juvenile idiopathic arthritis after treatment for presumed Kawasaki disease. J Pediatr. 2015; 166: 1283-1288.

  13. Kimura Y. Systemic juvenile idiopathic arthritis: clinical manifestations and diagnosis. UptoDate, Feb 2017. Available in: www.uptodate.com

  14. Behrens EM, Beukelman T, Gallo L et al. Evaluation of the presentation of systemic onset juvenile rheumatoid arthritis: data from the Pennsylvania Systemic Onset Juvenile Arthritis Registry (PASOJAR). J Rheumatol. 2008; 35(2): 343-348.

  15. Gurion R, Lehman TJ, Moorthy LN. Systemic arthritis in children: a review of clinical presentation and treatment. Int J Inflam. 2012; 2012: 271569.

  16. Calabro JJ, Marchesano JM. Rash associated with juvenilerheumatoid arthritis. J Pediatr. 1968; 72(5): 611-619.




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