Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2019; 7(1): 69-72
Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.69
Psoriatic fasciitis in a pediatric patient: A case report
Gulcin Otar Yener, Zahide Ekici Tekin, Selcuk Yuksel
Gulcin Otar Yener, Zahide Ekici Tekin, Selcuk Yuksel, Department of Pediatric Rheumatology, Pamukkale University School of Medicine, Denizli 20070, Turkey
Author contributions: Otar Yener G and Yuksel S designed the report; Otar Yener G, Ekici Tekin Z and Yuksel S collected the patient’s clinical data; Otar Yener G and Yuksel S analyzed the data and wrote the paper.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the guidelines of the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Selcuk Yuksel, MD, Professor, Department of Pediatric Rheumatology, Pamukkale University School of Medicine, Pamukkale, Denizli 20070, Turkey. selcukyuksel@yahoo.com
Telephone: +90-258-2965410 Fax: +90-258-2966001
Received: September 3, 2018
Peer-review started: September 3, 2018
First decision: November 2, 2018
Revised: November 26, 2018
Accepted: December 12, 2018
Article in press: December 12, 2018
Published online: January 6, 2019
Processing time: 124 Days and 17.6 Hours
Abstract
BACKGROUND

Diffuse fasciitis with psoriatic arthritis on magnetic resonance imaging (MRI) has not been previously described in childhood. Here we present the first case report of a pediatric patient developing fasciitis, beyond plantar fasciitis, with psoriatic arthritis.

CASE SUMMARY

An 11-year-old female was admitted with the complaints of psoriatic rash on the body associated with severe pain in the lower extremities and arthritis in the right knee. Psoriasis was confirmed by skin biopsy, she diagnosed with juvenile psoriatic arthritis. Diagnostic tests did not indicate any pathology except MRI. MRI of the femur and tibia revealed that high-signal inflammatory changes in the subdermal fascia. These findings led to a diagnosis of psoriatic fasciitis. Methotrexate was given for 3 mo but the patient showed no response to therapy; therefore, etanercept was added. However, there was no response to treatment. Etanercept was switched to adalimumab at the sixth month of therapy. Clinical improvement started with therapy of adalimumab within one month. Fasciitis finding in MRI disappeared at seventh months on adalimumab therapy. She has no complaint for two years with adalimumab.

CONCLUSION

The most effective imaging method is MRI and adalimumab may be the best choice of treatment for psoriatic fasciitis.

Keywords: Case report; Fasciitis; Psoriasis; Childhood; Arthritis

Core tip: Plantar fasciitis may be observed on magnetic resonance imaging (MRI) in patients with psoriatic arthritis. However, to our knowledge, MRI findings of diffuse fasciitis associated with psoriatic arthritis have not been previously described in a pediatric patient. Fasciitis should be considered in patients with psoriatic arthritis, especially with unresolved extremity pain. MRI seems to be the most effective imaging method and adalimumab may be the best choice of treatment for psoriatic fasciitis.