Knee Involvement
Rheumatol Int. 2009 Dec 16. [Epub ahead of print]
Mimicry of lyme arthritis by synovial hemangioma.
Hospach T, Langendörfer M, Kalle TV, Tewald F, Wirth T, Dannecker GE.
Pediatric Rheumatology, Department of Pediatrics, Olgahospital, Klinikum Stuttgart, Bismarckstr. 8, 70176, Stuttgart, Germany, a.hospach@klinikum-stuttgart.de.
Abstract
To report on the differential diagnosis of lyme arthritis and synovial hemangioma due to similar clinical and radiological signs and symptoms. A 15-year-old boy presented at the age of 9 with recurrent rather painless swelling of the right knee. Altogether four episodes lasting for 1-2 weeks each occurred over a period of 18 months before medical advice was sought. Physical examination revealed only a slightly limited range of motion. Living in an endemic area of borreliosis, he reported a tick bite 6 months prior to onset of his symptoms with erythema migrans and was treated for 10 days with amoxicillin.
Serology revealed two positive unspecific bands in IgG immunoblot (p41 and 66) with slight positivity for ELISA. Ultrasound revealed synovial thickening and increased fluid.
Despite the weak positive serology a diagnosis of lyme arthritis could not be excluded and intravenous antibiotic treatment with ceftriaxone was started.
After two further relapses antiinflammatory therapy including intraarticular steroids were introduced with no long lasting effect. A chronical disease developed with alternate periods of swelling and almost complete remission.
Ultrasound as well as MRI demonstrated ongoing signs of synovitis, therefore after further progression, a diagnostic arthroscopy was performed showing an inconspicuous knee joint.
A second MRI showed focal suprapatellar enhancement and was followed by open arthrotomy revealing a histopathological proven synovial cavernous juxtaarticular hemangioma.
To our knowledge, the differential diagnosis of lyme arthritis and synovial hemangioma has not yet been reported despite obvious clinical similarities. In conclusion, in children and adolescents synovial hemangioma has to be considered in differential diagnosis of recurrent knee swelling.
Early diagnosis is important to prevent prolonged suffering from chronic joint swelling with probable joint damages, unnecessary treatment procedures and as well school and sports absenteeism.
PMID: 20013264 [PubMed - as supplied by publisher]
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https://www.ncbi.nlm.nih.gov/pubmed/?term=Mimicry+of+lyme+arthritis+by+synovial+hemangioma
Rheumatol Int. 2007 Sep;27(11):1091-3. Epub 2007 Apr 4.
Seronegative Lyme arthritis.
Holl-Wieden A, Suerbaum S, Girschick HJ.
Children's hospital, Section of Pediatric Rheumatology, Immunology and Infectious diseases, University of Wuerzburg, Josef-Schneider-Str. 2, 97090 Wuerzburg, Germany.
Abstract
We present a 10-year-old girl who had been diagnosed with juvenile idiopathic arthritis 5 years before and who experienced a flare of arthritis affecting one knee while she was off medication for almost 3 years. Seronegative Lyme arthritis had to be diagnosed based on the detection of Borrelia burgdorferi DNA in synovial fluid. No humoral immune response to Borrelia burgdorferi was detectable before, at the time of diagnosis and up to 3 years later.
PMID: 17406870 [PubMed - indexed for MEDLINE]
Link Here
https://www.ncbi.nlm.nih.gov/pubmed/?term=Seronegative+Lyme+arthritis+Holl+2007
Rheumatol Int. 2007 Jun;27(8):747-51. Epub 2007 Mar 31.
Outcome of patients with arthritis and parvovirus B19 DNA in synovial membranes.
Schmid S, Bossart W, Michel BA, Brühlmann P.
Department of Rheumatology and Physical Medicine, University Hospital of Zurich, Gloria-strasse 25, 8091 Zurich, Switzerland.
Abstract
To investigate the follow-up of the 17 patients during the period of 1995-2001 of the outpatient Clinic for Rheumatology at the University Hospital of Zurich with arthritis and the presence of parvovirus B19 DNA demonstrated by PCR in synovial biopsies. Seventeen patients of 163 with arthritis, which were routinely examined by needle arthroscopy during 1995-2001 with a positive parvovirus B19 DNA by PCR of synovial biopsy were reevaluated. Investigations included medical history, clinical examination and blood tests. Joint fluid was taken on patients with joint effusion.
The observation period of the 17 patients (F:M = 11:6) was 2-8 years (Ø = 6.5 years). In 8 of 17 patients the arthritis could not be classified neither at entry nor during the follow up of the study.
The arthritis could be diagnosed in six patients early in the onset of the disease and included three cases of lyme arthritis of the knee joint, two cases with arthritis following a gastrointestinal infection (one with Salmonella typhimurium--positive faecal test--and the other one with a culture negative agent), one patient probably had an infection-associated arthritis after a gastrointestinal infection with Entamöeba histolytica (Schirmer et al. in Rheumatol Int 18:37-38, 1998; Kasliwal in Am J Proctol Gastroenterol Colon Rectal Surg 32:12, 16, 28, 1981; Haslock and Wright in J R Coll Phys Lond 8:1554-162, 1974; Than-Saw et al. in Trop Geogr Med 44:355-358, 1992) with remission after antibiotic therapy.
After a disease course of 9 months one patient could be classified as rheumatoid arthritis in the presence of anti-cyclic citrullinated antibodies but lack of rheumatoid factor.
One patient with polyarthritis developed psoriasis of the skin 22 months later. From the nine patients with unclassified arthritis 4 (45%) got into complete remission with no symptoms or signs of joint inflammation after a disease course of 9-45 months, whereas 5 (55%) still demonstrate active non erosive arthritis (disease duration between 3 and 10 years).
The presence of parvovirus B19 DNA in synovial tissue of patients with joint inflammation does not allow the diagnosis of parvovirus induced arthritis. If the arthritis remains unclassified and without erosions over time a virus associated aetiology may be assumed. However, no definitive diagnosis is possible even in the presence of parvovirus B19 DNA in synovial tissue.
PMID: 17401566 [PubMed - indexed for MEDLINE]
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