- On the question of differential diagnostics of articular syndrome in children: paraneoplastic arthritis
On the question of differential diagnostics of articular syndrome in children: paraneoplastic arthritis
PERINATOLOGIYA I PEDIATRIYA. 2017.2(70):121-125; doi 10.15574/PP.2017.70.121
Oshlyanska O. A., Omelchenko L. I., Ljudvik T. A.
SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv
Data on the clinical manifestations of paraneoplastic syndromes and the main mechanisms of their development are presented in the article. A case of arthritis in a child Ts. (boy of 14 years) is described. Anamnesis was not burdened. He had a history of an acute intestinal infection for 3 months before hospitalization, then in 3 weeks the patient complainted of pain and edema of the right knee joint, subfebrility, and NSAID therapy was administrated for 1 month, but had no effect. On examination, there was edema without local hyperthermia of the right knee joint with minimal restriction of flexion, «crunching» during movement. Other joints were intact. Dryness of the skin on the back surface of the hands, moderate difficulty in nasal breathing were detected. The general blood test was without pathological changes, ESR 10 mm/h, CRP negative, all serological markers were not increased. Ultrasound of the knee joint detected an exudative synovitis. Ultrasound of the thyroid gland: left;sided nodular goiter. The concenrations of T3, T4, TSH, ATPO were normal. A thinneedle aspiration biopsy of the thyroid gland was performed. The cytological test conclusion: papillary carcinoma of the thyroid gland. The clinical manifestations of gonarthritis stabilized after the surgery. The patient is currently followed up by the oncologist. In some cases, arthritis develops earlier than the neoplastic process is diagnosed. The clinician should pay attention to the lack of typical clinical and laboratory signs characteristic of juvenile arthritides and resistance to anti;inflammatory therapy.
Key words: children, paraneoplastic syndrome, arthritis.
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