Chronic arthritis in a child with primary agammaglobulinemia

Abstract

OBJECTIVES: To report a case of a child with Bruton's disease and the unusual association with chronic aseptic arthritis resembling juvenile rheumatoid arthritis. METHODS: A 16 month-old boy was seen at the Pediatric Rheumatology unit of HC-UFG and Hospital da Criança (Goiânia- GO). The authors evaluated relevant clinical and laboratorial features, including follow-up and response to therapy. The data were then compared to previous reports published in the world literature based on a Medline search of the subject. RESULTS: Since the age of 6 months, the patient had recurrent episodes of infection that responded poorly to antibiotics. Forty days before admission, he had onset of arthritis in his left knee. The diagnosis of Bruton's disease was based on the seric levels of immunoglobulins and the response to intravenous gammaglobulin infusions. Besides improvement with this therapy, clinical characteristics and other indirect laboratorial tests highly suggested the diagnosis of chronic, aseptic arthritis. CONCLUSION: We present a case of a rare association between Bruton's disease and chronic, aseptic arthritis, very similar to juvenile rheumatoid arthritis. Early recognition of this rare aseptic articular involvement is important for early and efficient therapy with intravenous gammaglobulin infusions, avoiding unnecessary hospital admissions and inappropriate use of antibiotics.