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Escalada-Pellitero S, García-Salido A, Clemente-Garulo D, Azorín-Cuadrillero D, De Lama Caro-Patón G, López-Robledillo JC. Fatal Pulmonary Veno-Occlusive Disease and Systemic Juvenile Idiopathic Arthritis: Case Report and Literature Review. Reumatol Clin (Engl Ed) 2023; 19:53-56. [PMID: 36603965 DOI: 10.1016/j.reumae.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/13/2021] [Indexed: 01/04/2023]
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a chronic childhood inflammatory disease. SJIA accounts for approximately 5-15 per cent of all cases of JIA and has a high morbidity and mortality rate. In this disease, pulmonary complications (PC) other than pleuritis are much less frequent and not easily recognised by clinicians. Pulmonary hypertension, the most severe PC, is associated with uncontrolled disease and use of biologic therapies. We present a case of a school-age female with sJIA who died of acute cardiopulmonary instability secondary to pulmonary venous-occlusive disease demonstrated by necropsy. We describe her clinical evolution. We also undertook a narrative review of the literature about PC in sJIA to discuss the current state of the art regarding this complication. High disease activity and the use of multiple therapies include disease-modifying anti-rheumatic drugs should be a red flag for clinicians when discounting PC and pulmonary hypertension. The combination of chest X-ray, electrocardiogram and echocardiogram appear to be the best tests to achieve an early diagnosis.
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Affiliation(s)
| | - Alberto García-Salido
- Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain.
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Storch-de-Gracia P, Leoz-Gordillo I, Andina D, Flores P, Villalobos E, Escalada-Pellitero S, Jiménez R. [Clinical spectrum and risk factors for complicated disease course in children admitted with SARS-CoV-2 infection]. An Pediatr (Barc) 2020; 93:323-333. [PMID: 32950434 PMCID: PMC7457908 DOI: 10.1016/j.anpedi.2020.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION At this time there are still major questions about the characteristics of disease caused by the new coronavirus (COVID-19) in children as well as factors associated with the development of severe forms of the disease. STUDY DESIGN Retrospective study including patients under 18 years of age admitted with SARS-CoV-2 infection from March 1 to April 30, 2020. Infection was confirmed by realtime reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody testing. We describe the epidemiological and clinical data, laboratory and imaging findings, as well as treatment and outcome in these patients. In light of these findings, patients were classified into two severity groups and then compared. RESULTS Thirty-nine children were included, with a median age of 9 years (range 12 days-16 years); 23 were boys. Cases with uncomplicated disease course (24) mostly presented to the emergency department (ED) with fever and/or respiratory symptoms without significant alterations in laboratory findings. Of the 15 children with a complicated course, 12 developed shock. In addition to fever, they frequently presented altered appearance, extreme tachycardia, abdominal pain, vomiting, diarrhea, rash, and/or conjunctival hyperemia. They also showed greater lymphopenia (p = 0.001), elevated neutrophil/lymphocyte ratio (p = 0.001), C-reactive protein (p < 0.001), procalcitonin (p = 0.001), D-dimer (p < 0.001), and ferritin (p < 0.001). CONCLUSIONS SARS-CoV-2 infection in admitted children presents with great clinical variability. When provided supportive care, patients with predominant respiratory symptoms without altered laboratory-test results generally have an uncomplicated course. Patients with complicated disease present mainly with fever and abdominal and/or mucocutaneous symptoms. Most develop shock. Elevation of inflammatory markers may allow for early detection and the final outcome is good.
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Affiliation(s)
| | - Inés Leoz-Gordillo
- Unidad de Cuidados Intensivos. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - David Andina
- Servicio de Urgencias. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Patricia Flores
- Servicio de Pediatría. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Enrique Villalobos
- Servicio de Pediatría. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - Raquel Jiménez
- Servicio de Pediatría. Hospital Infantil Universitario Niño Jesús, Madrid, España
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Storch-de-Gracia P, Leoz-Gordillo I, Andina D, Flores P, Villalobos E, Escalada-Pellitero S, Jiménez R. Clinical spectrum and risk factors for complicated disease course in children admitted with SARS-CoV-2 infection. An Pediatr (Barc) 2020; 93:323-333. [PMID: 33083499 PMCID: PMC7561329 DOI: 10.1016/j.anpede.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/29/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION At this time there are still major questions about the characteristics of disease caused by the new coronavirus (COVID-19) in children as well as factors associated with the development of severe forms of the disease. STUDY DESIGN Retrospective study including patients under 18 years of age admitted with SARS-CoV-2 infection from March 1 to April 30, 2020. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) or antibody testing. We describe the epidemiological and clinical data, laboratory and imaging findings, as well as treatment and outcome in these patients. In light of these findings, patients were classified into two severity groups and then compared. RESULTS Thirty-nine children were included, with a median age of 9 years (range 12 days-16 years); 23 were boys. Cases with uncomplicated disease course (24) mostly presented to the emergency department (ED) with fever and/or respiratory symptoms without significant alterations in laboratory findings. Of the 15 children with a complicated course, 12 developed shock. In addition to fever, they frequently presented altered appearance, extreme tachycardia, abdominal pain, vomiting, diarrhea, rash, and/or conjunctival hyperemia. They also showed greater lymphopenia (p = 0.001), elevated neutrophil/lymphocyte ratio (p = 0.001), C-reactive protein (p < 0.001), procalcitonin (p = 0.001), D-dimer (p < 0.001), and ferritin (p < 0.001). CONCLUSIONS SARS-CoV-2 infection in admitted children presents with great clinical variability. When provided supportive care, patients with predominant respiratory symptoms without altered laboratory-test results generally have an uncomplicated course. Patients with complicated disease present mainly with fever and abdominal and/or mucocutaneous symptoms. Most develop shock. Elevation of inflammatory markers may allow for early detection and the final outcome is good.
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Affiliation(s)
| | - Inés Leoz-Gordillo
- Unidad de Cuidados Intensivos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - David Andina
- Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Patricia Flores
- Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Enrique Villalobos
- Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Raquel Jiménez
- Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Torrelo A, Andina D, Santonja C, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, Hernández-Martín Á, de la Torre-Espi M, Colmenero I. Erythema multiforme-like lesions in children and COVID-19. Pediatr Dermatol 2020; 37:442-446. [PMID: 32445583 PMCID: PMC7283638 DOI: 10.1111/pde.14246] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS-CoV-2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS-CoV/SARS-CoV-2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID-19, and the positivity for SARS-CoV/SARS-CoV-2 spike protein by immunohistochemistry strongly suggest a link between EM-like lesions and SARS-CoV-2.
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Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - David Andina
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Lucero Noguera-Morel
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | | | | | | | - Isabel Colmenero
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, Hernández-Martín Á, de la Torre-Espi M, Colmenero I, Torrelo A. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol 2020; 37:406-411. [PMID: 32386460 PMCID: PMC7272985 DOI: 10.1111/pde.14215] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Different skin manifestations of COVID-19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the COVID-19 pandemic. MATERIAL AND METHODS A retrospective review of 22 children and adolescents with chilblain-like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID-19 in Madrid, Spain. RESULTS All patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D-dimer results, but without systemic symptoms or other laboratory anomalies. SARS-CoV-2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow-up, all cases showed spontaneous marked improvement or complete healing. CONCLUSION Acute chilblains were observed during COVID-19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.
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Affiliation(s)
- David Andina
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lucero Noguera-Morel
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | | | | | | | - Isabel Colmenero
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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