A case of multisystem inflammatory syndrome in children presenting as systemic onset juvenile idiopathic arthritis

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a rare and serious COVID 19 manifestation characterized by generalized inflammatory response including inflammation of heart, blood vessels, lungs, kidneys, brain, skin, eyes and gastrointestinal system. Children usually present with fever lasting for 24 hours or more along with other symptoms like abdominal pain, vomiting, diarrhea, skin rash, red eyes and swelling of the lips, tongue, hands and feet. The children with MIS-C usually have negative results for a current infection with the COVID-19 but positive antibody results indicating these children were infected with the COVID-19 virus in the past. We present 12 months old girl with multisystem inflammatory syndrome presenting as systemic onset juvenile idiopathic arthritis (SOJIA) and positive COVID-19 PCR, she was treated successfully with dexamethasone and naproxen. Continuous

Overlapping clinical features of systemic juvenile idiopathic arthritis and SARS-CoV-2-related multisystem inflammatory syndrome in children

“…The search for diagnostic markers aimed to make it possible to produce timely diagnosis of sJIA and prescribe appropriate treatment has attracted substantial attention in recent years [ 1 , 3 , 4 , 29 , 30 , 33 – 35 ] ( Table I ). Some studies focus on clinical signs [ 1 , 3 – 5 , 7 , 14 , 15 , 17 , 19 ], and others on laboratory indicators [ 24 , 29 , 30 ]. Fever refractory to intravenous immunoglobulin ( i.v.…”

“…At the same time, a good response to anti-inflammatory therapy should suggest MIS-C [ 15 ]. In the case of prolonged, recurrent fever, sJIA should also be suspected [ 3 , 17 ].…”

“…Ig) treatment was the most frequent indicator among the features of the clinical course [1,4,5,7,14,19]. At the same time, a good response to anti-inflammatory therapy should suggest MIS-C [15]. In the case of prolonged, recurrent fever, sJIA should also be suspected [3,17].…”

“…Thus, during the COVID-19 pandemic, doctors have been facing even greater challenges in diagnosing sJIA due to its clinical features overlapping with SARS-CoV-2-related MIS-C [ 14 , 15 ]. The cytokine storm of COVID-19 and hyperinflammation in MIS-C are both accompanied by fever and laboratory signs of inflammation, mimicking the systemic onset of JIA [ 16 ].…”

“…Therefore, clinicians can face challenges when diagnosing these diseases. Are these manifestations of the same disease [ 3 , 17 , 18 ], are they different diseases with the same clinical symptoms [ 14 , 15 ], or, finally, are they different diseases that follow one another [ 19 ]? Are there specific features that would distinguish one disease from another [ 20 ]?…”