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AB0953 Arthritis following parasitic infection in the differential diagnosis of juvenile idiopathic arthritis
  1. M Maschio1,
  2. S Pieropan2,
  3. F Caldonazzi1,
  4. G Dallagiacoma2,
  5. V Ravagnani3,
  6. D Degani1,
  7. G Piacentini1,
  8. D Biasi2,
  9. M Rossini2
  1. 1UOC pediatria
  2. 2UOC reumatologia, AOUI, Verona
  3. 3Reumatologia, Azienda Ospedaliera Carlo Poma, Mantova, Italy

Abstract

Background According to literature arthritis is a rare complication following parasitic infection. In the italian pediatric population parasitic infection is manly caused by Enterobius Vermicularis; it is often asymptomatic but common symptoms can be anal nocturnal itching, insomnia, irritability, abdominal pain together with arthralgia

Objectives To describe cases of mono or poliarthritis due to parasitic infection in young patients followed at the Verona's Pediatric Rheumathology Clinic from 2010 to 2016

Methods Medical records of 8 patients followed at the Pediatric Rheumatology were analyzed. The mean age of 8 patients was 8 (F:M 3:5). The following data were evaluated: anamnesis data, clinical symptoms (anal itching, irritability, arthralgia, abdominal pain and arthritis), Blood test and scotch tape test. All patients underwent joint ultrasound (US). Physical symptoms of joint's involvement were evaluated in all children by an experienced rheumatologist.

Results 6 patients had symmetrical poliathirtis, 2 patients had monoarthritis (knee and hand). Symptom's complaint were systemic (12,5%), abdominal (25%), and general pruritus (25%).Blood test confirmed high inflammation indices (25%) and hypereosinophilia (12,5%).Serological tests and stool investigations allowed to diagnose the following infections: Enterobius vermicularis (6 cases) giardia lamblia (1 case); dientaomeba fragilis (1 case).Joint US evidenced synovium hyperplasia in 75% of the cases and tenosynovitis in 50% of the cases.After appropriate antiparasitic treatment complete articular and systemic symptomatic remission was observed (100% cases); also joint US control normalized.2 cases, after about 6 months, were re-evaluated for arthritis relapse and in both cases a parasitic reinfection was confirmed.

Conclusions Analysis of this series of patients underlines the following data: arthritis can be a manifestation of parasitic infection; treatment must be aimed against the parasite involved in order to achieve complete clinical and laboratory data remission; reinfection must always be considered in cases of relapse; differential diagnosis of this form of arthritis with other chronic polyarthritis is fundamental due to the risk of disseminated infection in case of immunosuppressive treatment

Disclosure of Interest None declared

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