Diagnosis of paediatric Lyme arthritis using a clinical score

Huppertz, Hans‐Iko; Bentas, Wassilios; Haubitz, Imme; Girschick, Hermann; Ganser, Gerd; Thon, A.; Suschke, H.; Schauer-Petrowskaja, C; Minden, Kirsten; Schuchmann, L.

doi:10.1007/s004310050816

Cited by 23 publications

(11 citation statements)

References 20 publications

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“…For clinical diagnosis of lyme disease a score has been created using the highest rankings for the following criteria: episodic arthritis, adolescent age at onset, initial arthritis in knee joint, history of tick bite, low number of affected joints [14]. Also according to this score our patient would have been diagnosed with lyme disease.…”

Section: Discussionmentioning

confidence: 99%

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Mimicry of lyme arthritis by synovial hemangioma

et al. 2009

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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.

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Section: Discussionmentioning

confidence: 99%

“…Clinical features of lyme arthritis are rather well defined and the most characteristic sign is a relatively painless, often episodic massive swelling of a big joint, very often monoarticular and in 2/3 affecting the knee [14,15,28]. Predilected age range in hemangiomas as well as in lyme arthritis at diagnosis is adolescence [14,19].…”

Section: Discussionmentioning

confidence: 99%

Mimicry of lyme arthritis by synovial hemangioma

et al. 2009

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“…Several authors have attempted to formulate clinical diagnostic aids for diagnosis of Lyme arthritis in children. Huppertz described a clinical score for diagnosis of Lyme arthritis [11]. The aim was to reduce the need for serologic tests.…”

Section: Lyme Arthritismentioning

confidence: 99%

What we have learned about Lyme borreliosis from studies in children

Sood

2006

Wien Klin Wochenschr

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Although pediatric Lyme borreliosis (LB) need not be a separate nosological entity, there are clinically important differences in presentation, antibiotic regimens and outcomes in children, which provide lessons that can be extrapolated to the disease as it affects adults. A large proportion of the worldwide data is obtained from children. The aim of this presentation is not to present an exhaustive review of the pediatric literature, but to review a selection of pediatric studies that have made a significant contribution to our body of knowledge in Lyme borreliosis.

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“…Specific criteria have been combined to form a clinical diagnostic score that would confirm or exclude Lyme arthritis in two thirds of pediatric patients with arthritis (Huppertz et al, 1998) (Table 6.1). This score has not been validated in adults.…”

Section: Approach To Diagnosismentioning

confidence: 99%