Transient Synovitis of the Hip in a Pediatric Patient as an Atypical Initial Manifestation of COVID-19
Abstract
We report the case of a pediatric patient with transient synovitis of the hip as an initial atypical manifestation of a COVID-19 infection. A 7-year-old boy presented with gait disturbance, limping, and pain in his right hip. After 12 days, the patient continued with functional limitations and had associated symptoms such as fatigue and fever. Because of the atypical course, he was admitted to the hospital for joint aspiration. Due to institutional protocols, the preoperative evaluation included a COVID-19 PCR test. The joint aspiration sample showed clear synovial fluid with inflammatory characteristics and negative bacterial culture. COVID-19 PCR test results came out positive during the patient’s hospital stay. Clinical symptoms improved after the viral condition resolved. In the last follow-up, he was asymptomatic with a full hip range of motion. Transient synovitis of the hip could be an atypical initial symptom of a COVID-19 infection. Given the pandemic context of this disease, it is important to consider reactive arthritis as a consequence of this infection, especially in cases of atypical presentation, close family contact, fever, or other associated respiratory symptoms.Downloads
References
Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of
COVID-19. Nat Med 2020;26(7):1017-32. https://doi.org/10.1038/s41591-020-0968-3
Disser NP, De Micheli AJ, Schonk MM, Konnaris MA, Piacentini AN, Edon DL, et al. Musculoskeletal
consequences of COVID-19. J Bone Joint Surg Am 2020;102(14):1197-204. https://doi.org/10.2106/JBJS.20.00847
Whitelaw CC, Varacallo M. Transient Synovitis. 2021 Jun 29. En: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2021 Jan–. PMID: 29083677
Hoong CWS, Amin MNME, Tan TC, Lee JE. Viral arthralgia: a new manifestation of COVID-19 infection? A
cohort study of COVID-19-associated musculoskeletal symptoms. Int J Infect Dis 2021;104:363-9. https://doi.org/10.1016/j.ijid.2021.01.031
Zerrak A, Bour JB, Tavernier C, Dougados M, Maillefert JF. Usefulness of routine hepatitis C virus, hepatitis B
virus, and parvovirus B19 serology in the diagnosis of recent-onset inflammatory arthritides. Arthritis Rheum
;15;53(3):477-8. https://doi.org/10.1002/art.21182
Mokuda S, Tokunaga T, Masumoto J, Sugiyama E. Angiotensin-converting enzyme 2, a SARS-CoV-2 receptor, is
upregulated by interleukin 6 through STAT3 signaling in synovial tissues. J Rheumatol 2020;47(10):1593-5.
https://doi.org/10.3899/jrheum.200547
Wands JR, Mann E, Alpert E, Isselbacher KJ. The pathogenesis of arthritis associated with acute hepatitis-B surface antigen-positive hepatitis. Complement activation and characterization of circulating immune complexes. J Clin Invest 1975;55(5):930-6. https://doi.org/10.1172/JCI108022
Leibowitz E, Levin S, Torten J, Meyer R. Interferon system in acute transient synovitis. Arch Dis Child
;60(10):959-62. https://doi/org/10.1136/adc.60.10.959
Taffarel P, Jorro Barón F, Rodríguez AP, Widmer J, Meregallia C. Multisystem inflammatory syndrome in children related to COVID-19: An update regarding the presentation of two critically ill patients. Arch Argent Pediatr 2021;119(1):e26-e35. https://doi.org/0.5546/aap.2021.eng.e26
Baumann Q. Transient synovitis of the hip and SARS-CoV2. Temporality study about one case. Temporality study about one case. Ann Pediatr 2020;3(1):1025. https://meddocsonline.org/annals-of-pediatrics/transient-synovitis-ofthe-hip-and-SARS-CoV2-temporality-study-about-one-case.pdf
Sinaei R, Pezeshki S, Sinaei R, Shiari R, Yeganeh MH, Parvaresh S, et al. Post nCoV-2 limping child: report of two cases and a rapid review. Pediatr Rheumatol 2020. https://doi.org/10.21203/rs.3.rs-59943/v1
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
