Transient Synovitis Of Hip Research Articles

HHV-7 Encephalitis: The Rare Infection and Its Outcome on a Child (P11-10.006)

<h3>Objective:</h3> The primary aims of this study were to relate HHV-7 infection with clinical manifestations of encephalitis, transient hip synovitis and hepatic changes in childhood and to evidence the effectiveness of early diagnosis and treatment in patients with encephalitis. <h3>Background:</h3> A 2-year-old male patient reported persistent high fever, coughing and rhinorrhea starting 1 week ago. They sought outpatient pediatric care and was prescribed ceftriaxone and prednisolone, with no satisfactory response. The symptoms evolved to vomiting and dehydration. During the physical exam, he showed irritation, with constant cervical stiffness and hyperextension, photophobia, and convergent strabismus. On arrival, he had been taking ceftriaxone, acyclovir and desloratadine. Laboratory tests were very altered in leukocytes, platelets, PCR, AST, ALT and GGT. During the ophthalmologic examination, a paresis of cranial nerve VI on the right was identified as secondary to a probable meningitis. After 21 days of treatment with acyclovir, the patient had a good prognosis, however, he had claudication upon movement of the left hip. <h3>Design/Methods:</h3> NA <h3>Results:</h3> The CSF results were colorless, cloudy, pH 8, Glucose 58, Leukocytes 40, Proteins 81. To confirm this observation, the molecular panel detected the presence of HHV-7. The imaging tests helped and added to the results of the blood count and CSF. Cranial MRI showed a hyperintensity in the FLAIR sequence of the perimesencephalic subarachnoid space and small accumulation of liquid. In addition, the abdomen CT found a bit of fluid in the hip region. <h3>Conclusions:</h3> Encephalitis is an inflammation of the brain parenchyma that leads to neurological dysfunction caused by infection or autoimmunity. In this occasion, the patient had a rare case of HHV-7 encephalitis. Basically, the treatment was carried out with acyclovir and ketoprofen, obtaining a progressive improvement of the clinical picture. Consequently, further research on the complications of HHV-7 is essential to develop a good characterization of this disease. <b>Disclosure:</b> Mr. Andrade has nothing to disclose. Miss MARQUES has nothing to disclose. Dr. Mota has nothing to disclose.

Transient hip synovitis in an early adolescent: A rare case report

Transient hip synovitis in an early adolescent: A rare case report

Transient synovitis of the hip : is systematic radiological screening necessary for the detection of Perthes disease?

Current imaging guidelines in Belgium advise a systematic X-ray screening of the hips after an episode of transient synovitis of the hip, in order to detect Perthes disease. The aim of this study was to analyze whether systematic radiological screening is necessary for all children or whether the X-ray indication could be guided by clinical symptoms. A retrospective single center study including all children with the diagnosis of transient synovitis of the hip between 2013 and 2018 was performed. 242 patients with the diagnosis of one or more transient synovitis episodes were included, 102 of whom underwent a follow up X-ray. Persistence or recurrence of symptoms were recorded for all patients, as well as the results of follow-up hip X-rays. 12 children did not remain symptom-free after the episode of transient synovitis. Of these patients 10 had a normal follow-up X-ray and 3 were diagnosed with Perthes disease. 1 patient of those 3 had a normal X-ray but was diagnosed with Perthes disease on MRI. Of the children which remained symptom-free after the episode of transient synovitis, none were diagnosed with Perthes disease afterwards. A follow-up X-ray to exclude Perthes disease after a diagnosis of transient hip synovitis appears to be necessary only in patients with persistent or recurrent symptomatology.

La hanche chez l’enfant de 0 à 17 ans

In children, hip diseases are revealed by a walking disorder or limping, which requires physical examination and imaging by ultrasound, radiography and, depending on the case, MRI. The diagnoses differ according to age and the inflammatory or mechanical nature of the symptoms. Before the age of two, two diagnoses are encountered: septic arthritis (therapeutic emergency) and hip dysplasia, which must be systematically screened. After two years the most common cause of acute hip arthritis is transient hip synovitis; juvenile idiopathic arthritis may be revealed by an initial hip injury (especially in the case of spondyloarthropathies); cases of villo-nodular synovitis and osteochondromatosis are rare; bone may also be involved (recurrent multifocal osteitis, osteoid osteoma or much more rarely malignant tumor). Mechanical hip pain is more common in boys: osteochondritis (Legg-Perthes-Calvé disease) occurs between 4 and 8years of age, epiphysiolysis is observed later at around 13/14years of age in boys often overweight; it can be complicated by chondrolysis. Apophysitis in the greater trochanter, iliac spines or ischium can also cause hip pain in children aged 12 to 15years old practicing many sports.

Clinical value of B ultrasonography in the diagnosis of transient synovitis of hip in dogs

To investigate the value of B ultrasonography in the early diagnosis of transient synovitis of hip (TSH) in dogs, and provide the valid base and data for the clinic early diagnosis of TSH. Eighty 2-3 month old dogs were injected 0.2% noradrenalin (NA) into the hip joint induced TSH. We observed 5 assessments that included the 99mTC-MDP triphasic imaging, X ray, B ultrasonography, the synovial fluid and the pathological tissue check in different time. Early course of TSH presented the synovium of joint hemangiectasis, hyperaemia, synovium villus hyperplasia, edema, and joint inflammatory exudation. The ischemia of local blood supply of the femoral head was observed by 99mTC-MDP triphasic imaging. Ultrasonography showed the broadening of the anterior space of the hip, but the X ray showed no valid changes. B ultrasonography can report the early changes of TSH and may be used in the early diagnosis of TSH in children.

AB1177 Aggressive sacroiliitis in a 4-year-old patient. Successful anti tnf treatment

BackgroundEnthesitis-related arthritis represents 3-11% of all patients with juvenile idiopathic arthritis (JIA). It affects more frequently males over 6 years old. This condition courses with arthritis that in the 90%...

Características de los pacientes con cojera en Reumatología

IntroductionLimping is a frequent reason for consultation. Our aim is to describe the characteristics of patients who limp and are evaluated in Rheumatology. Material and MethodsCross-sectional study from October 2009 to June 2010. Variables included: epidemiological data, clinical symptoms and laboratory and imaging tests. ResultsA total of 95 patients were studied and classified into four groups according to their diagnosis, inflammatory 22%, infectious 17%, transient hip synovitis 13%, and miscellaneous 48%. There were differences between groups in age (P<0.0001) and arthritis (P<0.0001). In this population, the probability of an infectious/inflammatory limp fulfils the criteria “less than 3 years and fever” was 79% and reached 100% if it was also associated with arthritis. ConclusionsClinical evaluation and in particular, age, fever and arthritis seem to be the most relevant data in differentiating infectious/inflammation diagnosis in the child who limps.

Misdiagnosis of Ewing’s sarcoma of the ilium at the pelvis X-ray

DiVerential diagnosis of coxalgia in young patients requires that transient hip synovitis (also known as “irritable hip”) is distinguished from septic arthritis, Legg-Calve-Perthes disease (an idiopathic avascular osteonecrosis of the femoral epiphysis), slipped capital femoral epiphysis, and pyomyositis. Transient hip synovitis recurs in up to 15% of children and may aVect the same or opposite hip [1]. Juvenile idiopathic arthritis might frequently involve the hip joint, resulting in functional impairment prior to the closure of the proximal femoral capital epiphysis [2]. X-ray Wlms, ultrasonography, and magnetic resonance imaging (MRI) are the most common instrumental tools used to assess the pediatric hip, but false negative results may occur and clinical correlation is necessary. We report the case of a 12-year-old girl who presented left hip pain, Wrstly treated with paracetamol with partial success. The patient was then admitted in a Wrst hospital for the persistent symptom: clinical examination showed restricted internal and external rotation of left hip, altered gait, and mild fever. Coxo-femoral echography showed a mild nonspeciWc left hip eVusion, suggesting the diagnosis of transient synovitis, which was treated with ibuprofen for 15 days. Pain remission was total, but in the following 3 months hip pain reappeared occasionally, though it was related to patient’s obesity (weight 62 kg, BMI 34.5). Pelvis X-ray was reported as normal at this Wrst reading. A new admission in a second hospital showed these laboratory results: Hb 10.4 g/dl, white blood cell count 12,690/ mm, platelet count 339,000/mm, erythro-sedimentation rate 73, C-reactive protein 62 mg/l, lactate dehydrogenase 429 IU/l, ferritin 159 ng/dl, and alkaline phosphatase 139 IU/l. Quantiferon test was negative. Contrast-enhanced MRI of the hip revealed an unexpected large lytic lesion in the left iliac wing, destructing the internal cortical zone (Fig. 1). Histopathology of the lesion revealed a malignant round-cell tumor consistent with Ewing’s sarcoma (ES). As a result of this diagnosis, we compared the antero-posterior view of pelvis X-ray containing the tumor area (Fig. 2) with MRI scans and found that the same osteolytic lesion in the iliac bone was misdiagnosed as a meteoric bowel distention. The sharp and clearly deWned margins without motheaten lesions might have contributed to the initial wrong false negative diagnosis. ES is the second most common primary malignant bone neoplasm in children and adolescents, accounting for approximately 10% of malignant bone tumors [3]. Frequently ES is located in the pelvis, and iliac bone is frequently involved [4]. ES of the ilium mimicking sacroiliitis has been reported [5]. Clinically ES initial symptom may be confused with infectious or rheumatologic diseases, and the classic radiological presentation of an intramedullary lesion with aggressive permeative or moth-eaten bone destruction on plain radiographs may not be the rule [6]. The value of plain Wlms of this area is compromised by the anatomy of the iliac bone and by the overlying structures; F. De Maddi · P. Siani Department of Pediatrics, Cardarelli National Hospital, Via A. Cardarelli 9, 80131 Naples, Italy

Urine glycosaminoglycans in children with transient hip synovitis and Perthes disease

Urine glycosaminoglycan concentrations were measured in 24-h urine samples collected from ninety children (30 children with Perthes disease, 30 with transient synovitis and 30 control participants). Significantly decreased levels of urine glycosaminoglycans were found in Perthes disease patients compared with those with transient synovitis and the control group.

The Significance of Arthrocentesis on Transient Synovitis of the Hip in Children

Purpose: To evaluate the significance of arthrocentesis on transient synovitis of hip in children with a moderate degree of limping and large joint effusion. Materials and Methods: 119 cases of transient synovitis of the hip were evaluated retrospectively between January 1999 and December 2003, with respect to age (mean age: 5.6 years), sex (M:F=89:30), location (Right:Left=68:51), chief complaints (limping: 72; hip pain: 39; knee pain: 37), physical examination (limited internal rotation: 98), sonography of capsule neck distance (mean 5.9 mm), duration of hospitalization and morbidity. Among them, 47 cases with greater than 8 mm in capsule neck distance on sonography were compared, based on the duration of hospitalization, morbidity, and the change of capsule bulging between 18 cases in the arthrocentesis group and 29 cases in the non-arthrocentesis group. Results: The mean duration of hospitalization and morbidity were 1.7 days, 4.7 days in the arthrocentesis group and 2.1 days, 6.6 days in the non-arthrocentesis group, the distance of the capsule bulging decreased from 9.2 mm to 4.5 mm in the arthrocentesis group and from 9.0 mm to 7.6 mm in the non-arthrocentesis group. The duration of hospitalization, morbidity, clinical course and decrease in capsule bulging were more effective, statistically in the arthrocentesis group than in the non-arthrocentesis group. Conclusion: Arthrocentesis for transient synovitis can be effective method of treatment in cases of moderate degrees of limping and large joint effusions,in spite of the disadvantage of the invasiveness of the rocedure.

Juvenile rheumatoid arthritis.

1. Jane G. Schaller, MD* 1. 2. *David and Leona Karp Professor of Pediatrics; Chair, Department of Pediatrics, Tufts University School of Medicine, Boston, MA. 1. There are several recognizable subgroups of juvenile rheumatoid arthritis (JRA): systemic-onset, polyarticular, pauciarticular, and late childhood onset. 2. Rheumatoid factor usually is negative in JRA. 3. Systemic-onset JRA is characterized by high intermittent fevers and other extra-articular manifestations: lymphadenopathy, rash, pleuritis, and pericarditis. 4. Iridocyclitis is absent in acute-onset disease but common in patients who have pauciarticular disease. 5. Nonsteroidal anti-inflammatory drugs (NSAIDs) remain the front-line and important agents in the therapy of patients who have JRA. 6. Controlled studies show that d-penicillamine, hydroxychloroquine, and oral gold are no more effective than placebo in the treatment of JRA. Juvenile rheumatoid arthritis (JRA) is a term used to describe the condition of chronic synovitis in children of which there are several distinct subgroups. Chronic synovitis in children was first described well in the English literature in 1897 by George Frederick Still, an English pediatrician and pathologist, who reported on 23 children who had chronic arthritis and came to his attention while he was training at the Hospital for Sick Children, Great Ormond Street. Still postulated that several separate conditions were responsible for chronic arthritis in children. Little subsequent work in this area was pursued until the late 1940s. Most modern observers have come to agree with Still that chronic arthritis in children encompasses several distinct disease subgroups (Table 1⇓ ). The relationship of JRA to adult rheumatoid arthritis was uncertain for many years. Now it seems clear that the classic adult-type rheumatoid arthritis does occur in children but is quite rare, the JRA subgroups seronegative 1 polyarthritis and systemic-onset disease also occur in adults but not frequently, the pauciarthritis of early childhood has not been recognized in adults, and the pauciarthritis of older children usually is classified as spondyloarthropathy in adults. The nomenclature for chronic childhood arthritis remains confusing (Table 2⇓), but …

Extruding Synovitis of the Hip in Childhood: A Case Report

The authors describe an unusual case of extrusive synovitis of the hip that they believe is an anatomo-clinical variant of transient synovitis of the infantile hip. Transient synovitis of the hip (TSH) is a benign pathology of the hip with complete healing within a few days after onset of the disease. The case reported distinguishes itself for the expulsive tendency of the femoral head from the acetabular cavity with potential ischemic disturbances due to an increased pressure inside the articular joint causing stretching of the circumflex vessels supplying the femoral head.

Benign synovitis of the hip in adults.

Hip synovitis plays a part in many rheumatic diseases. In the young adult acute arthritis may be due to reaction to trauma, infection or gout. Although transient synovitis of the hip is a well-known phenomena in children the condition is not well-documented in adults. We present 10 young adults with idiopathic transient synovitis of hip who had attended the Soroka Medical Centre between 1986 and 1990.

Ultrasonography in Transient Synovitis of Hip

Ultrasonography in Transient Synovitis of Hip

Transient synovitis of hip. A virological investigation.

Virological studies in 17 children with transient synovitis of the hip did not confirm the suggestion that this is caused by a viral infection. Minor trauma is thought to be a more likely cause.

Nontraumatic subluxation of the atlanto-axial articulation.

On encountering an instance of nontraumatic subluxation of the atlanto-axial joint, we noted that some of its features resembled those of transient synovitis of the hip joint. We decided to explore the mechanism and history of this cervical condition in order to determine whether it might have the same underlying cause as transient hip synovitis. REPORT OF A CASE A white boy, aged 7 years, was admitted to the hospital on June 6, 1951. His mother reported that three weeks before admission the child suffered from an upper respiratory infection and enlarged cervical nodes, for which he was given antibiotics. A week later, the child began to tilt his head to the right and suffered severe pain when he attempted to raise or turn his head. Examination showed that the child tilted his head sharply to the right, with his chin pointing upward and to the left. The normal cervical