ASAS definition for sacroiliitis on MRI in SpA : applicable to children?

Background: The Assessment of Spondyloarthritis International Society (ASAS) definition for a'positive' Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is to evaluate whether the adult ASAS definition of a positive MRI of the sacroiliac joints can be applied to children with a clinical suspicion of Juvenile Spondyloarthritis (JSpA). Methods: Two pediatric musculoskeletal radiologists blinded to clinical data independently retrospectively reviewed sacroiliac (SI) joint MRI in 109 children suspected of sacroiliitis. They recorded global impression (sacroiliitis yes/no) and whether the adult ASAS definition for sacroiliitis was met at each joint. This was compared to goldstandard clinical diagnosis of JSpA. Additionally, MRI were scored according to'adapted' ASAS definitions including other features of sacroiliitis on MRI. Results: JSpA was diagnosed clinically in 47/109 (43%) patients. On MRI, sacroiliitis was diagnosed by global assessment in 30/109 patients, of whom 14 also fulfilled ASAS criteria. No patients with negative global assessment for sacroiliitis fulfilled ASAS criteria. Sensitivity (SN) for JSpA was higher for global assessment (SN = 49%) than for ASAS definition (SN = 26%), but the ASAS definition was more specific (SP = 97% vs. 89%). Modifying adult ASAS criteria to allow bone marrow edema (BME) lesions seen on only one slice, synovitis or capsulitis, increased SN to 36%, 32% and 32% respectively, only slightly lowering SP. Including structural lesions increased SN to 28%, but lowered specificity to 95%. Conclusion: The adult ASAS definition for sacroiliitis has low sensitivity in children. A pediatric-specific definition of MRI-positive sacroiliitis including BME lesions visible on one slice only, synovitis and/or capsulitis may improve diagnostic utility, and increase relevance of MRI in pediatric rheumatology practice

A synchronous papillary and follicular thyroid carcinoma presenting as a large toxic nodule in a female adolescent

Case presentation We report for the first time a synchronous papillary and follicular thyroid carcinoma in a 12-year-old girl presenting with a large (5 cm diameter) left thyroid nodule, an increased left and right upper pole technetium tracer uptake at scintigraphy and hyperthyroidism. The uptake at the right lobe was explained by the crossing of the left nodule to the right site of the neck at Computed Tomography (CT) scanning. Background Although thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy. According to literature, about 5% of the thyroid nodules in adults are malignant versus 20-26% in children. The characteristics of 9 other pediatric cases with a differentiated thyroid carcinoma presenting with a toxic nodule, which have been reported during the last 20 years, are summarized. A nodular size of more than 3.5 cm and female predominance was a common finding. Conclusions The presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion

Vitamine B12 deficiency in children : a diagnostic challenge

Cobalamin or vitamin B12 (vitB12) is involved in DNA synthesis, haematopoiesis and myelinisation. Consequently, vitB12 deficiency causes various symptoms, such as megaloblastic anaemia, neurologic signs or pancytopenia. Despite possible severe symptoms, vitB12 deficiency can present asymptomatically. We report six paediatric patients with different aetiologies of vitB12 deficiency ranging from a subtle to a more overt presentation. VitB12 deficiency is a diagnostic challenge due to the lack of consensus on normal values of vitB12 and its co-markers (folate, holotranscobalamin, methylmalonic acid, homocysteine) and the lack in specificity and sensitivity of the serum vitB12 analysis. All cases were treated with parenteral vitB12. Last decades, evidence supporting high dose oral treatment being as effective as the intramuscular (IM) therapy, also in children, is growing

SeroCovid<19: prospective seroprevalence monitoring reveals substantially reduced SARS-CoV-2 infection rate among tertiary pediatric patients

Background Coronavirus disease 2019 (COVID-19) is a clinically heterogeneous entity with several host, environmental, and viral risk factors identified to date. COVID-19 in children generally manifests asymptomatic or mild. Pediatric patients with chronic medical conditions are potentially at increased risk for severe COVID-19, although convincing data is lacking. Among these children, we aimed to study COVID-19 incidence and disease severity. Methods We initiated a prospective cohort study with longitudinal (every 3-6 months) quantification of serum SARS-CoV-2 IgG (Abbott) and questionnaires in pediatric patients (0-18y) with chronic medical conditions in follow-up at Ghent University Hospital, a tertiary referral center. This interim analysis incorporates inclusions from Nov 1, 2020 until Jan 14, 2021. Results Here, we present data of the first 250 included patients (mean age 10.4y). Chronic conditions required follow-up at departments of immunology (26.4%), nephrology (16.7%), rheumatology (15.4%), gastroenterology (14.5%), endocrinology (8.8%), pulmonology (8.8%) or others (9.3%). Chronic immunosuppressive drugs were used in 35.6%. Inborn errors of immunity, possibly affecting antibody responses, were present in 18.0%. Restriction from school or daycare centers (additional to general lockdown and school closures) was documented in 35.1% and 10.7%, before and after the summer break, respectively. Since the start of the pandemic, close contacts with proven COVID-19 were known in 21.0%. An overall SARS-CoV-2 seroprevalence of 6.0% (15/250) was found, substantially lower than concurrently reported in Belgian blood donors and health care workers (14.4% in Nov 2020), and on the lower end compared to healthy children measured prior to the second epidemic wave in Flanders (4.4-14.4% in Sept-Oct). Asymptomatic COVID-19 was documented in 7/15. One patient with cystic fibrosis (9y) required hospitalization. All other cases experienced mild COVID-19, at most. Of seropositive cases, 5/15 received immunosuppression, all experiencing mild infection. Conclusion A strikingly low SARS-CoV-2 seroprevalence was found in our cohort. Despite no supplementary preventive measures were imposed for the majority, this cohort seemed additionally shielded from SARS-CoV-2. Asymptomatic COVID-19 was present in half of cases. These findings may be of importance for ongoing and future protective measures, clinical management, and vaccination strategies in these population