Juvenile dermatomyositis: Five new cases during the SARS-Cov2 pandemic

ABSTRACT

Objectives: To describe the clinical and laboratory characteristics of pediatric patients diagnosed with dermatomyosis during the COVID pandemic. Method: Description of the clinical and laboratory findings in patients under 15 years of age, who were admitted at our hospital with signs and symptoms suggestive of dermatomyositis, from March 2020 until November 2021. Results: Five patients, three boys and two girls, aged between 8 and 13 years, were diagnosed with juvenile dermatomyositis (JDM). The most frequent symptom was asthenia. Heliotrope erythema, malar rash, periungual erythema, and papules on elbows and knees were present in all cases. Three of our patients had perniosis on their toes. Four patients presented lesions in the oral mucosa, such as geographic tongue or gingivitis. The time between the onset of symptoms and the first visit with the pediatrician ranged from 1 to 6 months. In all cases, GOT/GPT enzymes, and aldolase were elevated at diagnosis, and the SARS-CoV-2 PCR was negative. Two patients had anti-TIF1 antibodies, and two had anti-MDA5 antibodies. In one girl, no specific autoantibodies for JDM were detected. Magnetic resonance imaging showed muscle oedema in all patients. All cases are in remission after systemic treatment with steroids, methotrexate or immunoglobulins. Discussion: JDM is a severe disease of childhood. Our cases did not present symptoms suggestive of COVID and the PCR for SARS-CoV-2 was negative on admission in all of them, but the presence of perniosis on the toes of three patients could correspond to “COVID toes,” and be a late manifestation of an asymptomatic or oligosymptomatic infection of SARS-CoV-2. It has been suggested that SARS-CoV-2 infection could trigger the development of JDM, possibly through the induction of IFNα. Long-term follow-up is necessary to establish a relationship between the prognosis of specific autoantibodies, the involvement of acral and mucosal areas, and the possible relation with COVID.