A hyper-ferritinemia syndrome evolving in recurrent macrophage activation syndrome,as an onset of amyopathic juvenile dermatomyositis: A challenging clinical case in light of the current diagnostic criteria |
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Authors: | Dimitri Poddighe Lorenzo Cavagna Valeria Brazzelli Paola Bruni Gian Luigi Marseglia |
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Institution: | 1. Department of Pediatrics, Azienda Ospedaliera di Melegnano, Milan, Italy;2. Department of Rheumatology, IRCCS Fondazione Policlinico San Matteo di Pavia, Italy;3. Department of Dermatology, IRCCS Fondazione Policlinico San Matteo di Pavia, Italy;4. Department of Pediatrics, IRCCS Fondazione Policlinico San Matteo e Universita'' degli Studi di Pavia, Italy |
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Abstract: | Juvenile dermatomyositis is an immune-mediated inflammatory multi-system disease involving mainly striated muscles and skin. Typical dermatological features are fundamental to establish the diagnosis, especially whenever the myopathy is very mild or absent, as it occurs in the form called as amyopathic juvenile dermatomyositis. Sometimes, systemic rheumatic diseases can develop a hyperferritinemia syndrome characterized by hemophagocytosis, namely macrophage activation syndrome, which represents a severe and life-threatening complication. Here, we describe a complex clinical history characterized by a hyper-ferritinemia syndrome after infectious mononucleosis, leading to recurrent episodes of macrophage activation syndrome. Finally, the late onset of several skin changes brought to a diagnosis of amyopathic juvenile dermatomyositis. |
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Keywords: | JDM Juvenile dermatomyositis MAS macrophage activation syndrome HLH hemophagocytic lymphohistiocytosis IM infectious mononucleosis sJRA systemic onset juvenile arthritis SLE systemic lupus erythematosus CRP C-reactive protein ESR erythrocyte sedimentation rate US ultrasonography IV intra-venous CSA cyclosporine-A N Neutrophils L Lymphocytes M Monocytes E Eosinophils B Basophils |
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