Scientific Letters
Dactylitis, early onset of drepanocytosis and a predictor of a poor prognosis
Dactilitis, debut precoz de drepanocitosis y predictor de mal pronóstico
a Departamento de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
b Departamento de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
c Departamento de Hematología y Oncología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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The modifications considered were: addition, if other agent(s) were added to the original prescription; reduction, if the original treatment consisted of two or more agents and the discharge prescription included fewer of them; change, if the final prescription differed in at least one to all the antipyretic agents; withdrawal, if antipyretic treatment was discontinued completely; same prehospital and discharge when the antipyresis scheme was only modified during the hospital stay. 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Solé-Ribalta, M. Vilà-de-Muga, A. Català-Temprano, C. Luaces-Cubells" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Solé-Ribalta" "email" => array:1 [ 0 => "asole@hsjdbcn.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Vilà-de-Muga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Català-Temprano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Luaces-Cubells" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Urgencias de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Hematología y Oncología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dactilitis, debut precoz de drepanocitosis y predictor de mal pronóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1445 "Ancho" => 1000 "Tamanyo" => 106913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left hand radiograph: periostic reaction in the fifth metacarpal bone.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sickle cell disease is an inherited monogenic disease. The most frequent form is due to a homozygous mutation in the β<span class="elsevierStyleSup">S</span> allele that encodes haemoglobin S.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Its clinical course, while highly variable, is characterised by chronic haemolytic anaemia and vaso-occlusive events leading to early multiorgan failure.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 7-month-old infant who was brought to the emergency department because of swelling in the left hand, with no evidence of preceding trauma, preserved spontaneous movement and no fever. The family was from Equatorial Guinea and the patient had resided in Spain since birth. The pregnancy, delivery and neonatal period had passed without complications. The patient was up to date with the routine immunisation schedule and had not been vaccinated against pneumococcus. There was no family history of interest.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination showed that the patient was stable, with appropriate anthropometric values and vital signs. He had swelling in the dorsal aspect of the left hand that was tender to palpation, with no other signs of inflammation; examination of the remaining organ systems was normal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">An initial radiographic examination (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed a periostic reaction at the fifth metacarpal bone.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">At this point, the differential diagnosis included bone tumour, osteomyelitis and bone infarction in the context of sickle cell disease. Laboratory analyses revealed a regenerative microcytic anaemia (haemoglobin [Hb]: 8.6<span class="elsevierStyleHsp" style=""></span>g/dL, mean cell volume<span class="elsevierStyleHsp" style=""></span>70<span class="elsevierStyleHsp" style=""></span>fL, reticulocytes 7.4%), with normal values for the rest of the complete blood count; normal coagulation, negative direct and indirect Coombs tests, normal bilirubin and haptoglobin levels, lactate dehydrogenase 706<span class="elsevierStyleHsp" style=""></span>Ul/L, and a normal iron panel; the morphological study of red blood cells revealed sickle cells. Serological tests for CMV, treponema, HIV, HCV, EBV and VZV were negative, and the patient tested negative for antiHBc and HBSAg and positive for antiHBs; the urine test was normal. In light of the results of the diagnostic tests and the suspicion of sickle cell disease and dactylitis, intravenous fluid therapy and analgesic treatment with paracetamol were initiated. On the second day after admission the diagnosis was confirmed by analysis of haemoglobin variants (HPLC) (HbF: 26.9%; HbA2: 2.1%; HbS: 50%). Prophylaxis with penicillin was initiated, and the patient was given the pneumococcal vaccine (Prevenar 13<span class="elsevierStyleSup">®</span>). The patient had a favourable outcome with gradual resolution of the local inflammatory signs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Dactylitis, or hand-foot syndrome, is an episode of vaso-occlusive pain in small bones of the hands and feet that typically develops in children younger than 4 years with sickle cell disease, as at later ages the haematopoietic tissue in these locations is replaced by fibrous connective tissue and fat.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Vaso-occlusive bone pain often constitutes the onset of sickle cell disease. It presents with pain and oedema, and is often accompanied by mild erythema and low-grade fever.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Radiographic examination usually only shows a soft tissue oedema in the early stages, and may show bone abnormalities at a later stage. Osteomyelitis and cancerous conditions must be considered in the differential diagnosis, as they have similar clinical and radiological features, and their differentiation is crucial considering how differently these conditions are managed. The development of dactylitis in the first year of life, along with severe anaemia and leukocytosis in the first 2 years of life, has been described by some authors as predictors of severe disease associated with adverse events (acute chest syndrome, frequent pain crises, stroke or death). Its treatment involves hydration and pain management.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Our patient was readmitted 15 days later due to a 2-day history of fever with concomitant vomiting and diarrhoea without pathological products. The general health status was fair, with asthenia, pallor, and mild dehydration. The most salient features of the examination were a splenomegaly of 3<span class="elsevierStyleHsp" style=""></span>cm in the absence of hepatomegaly and hyperactive bowel sounds. Laboratory analysis revealed the following levels: Hb 4<span class="elsevierStyleHsp" style=""></span>g/dL (previous value: 8.1<span class="elsevierStyleHsp" style=""></span>g/dL), platelets: 75<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">3</span> (previous: 207<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">3</span>), leukocytes: 20<span class="elsevierStyleHsp" style=""></span>500<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">3</span> (neutrophils: 9200<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">3</span>). The comprehensive metabolic panel was normal. The levels of C-reactive protein and procalcitonin were 48.9<span class="elsevierStyleHsp" style=""></span>mg/L and 4.57<span class="elsevierStyleHsp" style=""></span>ng/mL, respectively.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Since severe splenic sequestration was suspected, an urgent transfusion of red blood cell concentrate was performed, and intravenous (IV) rehydration therapy and empirical treatment with IV ceftriaxone were initiated.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> The patient had a favourable outcome, as he did not require further transfusions and his platelet levels recovered.</p><p id="par0045" class="elsevierStylePara elsevierViewall">After 6 days of receiving ceftriaxone and obtaining negative blood, urine and stool culture results and a positive result for rotavirus, intravenous antibiotic treatment was discontinued and prophylactic treatment with penicillin resumed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">This patient is being treated with chronic exchange transfusions to maintain HbS levels below 30% (carrier levels) and is a candidate for splenectomy at 2 years of age to prevent recurrence, a measure that is still controversial but that is approved by current guidelines.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Solé-Ribalta A, Vilà-de-Muga M, Català-Temprano A, Luaces-Cubells C. Dactilitis, debut precoz de drepanocitosis y predictor de mal pronóstico. An Pediatr (Barc). 2015;82:267–268.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1445 "Ancho" => 1000 "Tamanyo" => 106913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left hand radiograph: periostic reaction in the fifth metacarpal bone.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sickle-cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.C. Rees" 1 => "T.N. Williams" 2 => "M.T. Gladwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(10)61029-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2010" "volumen" => "376" "paginaInicial" => "2018" "paginaFinal" => "2031" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21131035" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sickle cell disease in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.R. Meier" 1 => "J.L. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/11632890-000000000-00000" "Revista" => array:6 [ "tituloSerie" => "Drugs" "fecha" => "2012" "volumen" => "72" "paginaInicial" => "895" "paginaFinal" => "906" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22519940" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteoarticular involvement in sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.B. Da Silva Junior" 1 => "F. Daher Ede" 2 => "F.A. da Rocha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5581/1516-8484.20120036" "Revista" => array:6 [ "tituloSerie" => "Rev Bras Hematol Hemoter" "fecha" => "2012" "volumen" => "34" "paginaInicial" => "156" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23049406" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sickle cell disease in children: differentiating osteomyelitis from vaso-occlusive crisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Berger" 1 => "N. Saunders" 2 => "L. Wang" 3 => "J.N. Friedman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archpediatrics.2008.545" "Revista" => array:6 [ "tituloSerie" => "Arch Pediatr Adolesc Med" "fecha" => "2009" "volumen" => "163" "paginaInicial" => "251" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19255393" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of adverse outcomes in children with sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.T. Miller" 1 => "L.A. Sleeper" 2 => "C.H. Pegelow" 3 => "L.E. Enos" 4 => "W.C. Wang" 5 => "S.J. Weiner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200001133420203" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "342" "paginaInicial" => "83" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10631276" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Care of the asplenic patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.G. Rubin" 1 => "S. William" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMcp1314291" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "371" "paginaInicial" => "349" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25054718" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008200000004/v2_201505130138/S2341287915000423/v2_201505130138/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008200000004/v2_201505130138/S2341287915000423/v2_201505130138/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000423?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 8 | 19 |
| 2024 October | 92 | 40 | 132 |
| 2024 September | 102 | 41 | 143 |
| 2024 August | 100 | 72 | 172 |
| 2024 July | 98 | 35 | 133 |
| 2024 June | 113 | 36 | 149 |
| 2024 May | 102 | 38 | 140 |
| 2024 April | 69 | 44 | 113 |
| 2024 March | 73 | 28 | 101 |
| 2024 February | 77 | 26 | 103 |
| 2024 January | 107 | 24 | 131 |
| 2023 December | 154 | 24 | 178 |
| 2023 November | 126 | 34 | 160 |
| 2023 October | 69 | 27 | 96 |
| 2023 September | 52 | 23 | 75 |
| 2023 August | 57 | 22 | 79 |
| 2023 July | 108 | 24 | 132 |
| 2023 June | 97 | 32 | 129 |
| 2023 May | 121 | 23 | 144 |
| 2023 April | 80 | 20 | 100 |
| 2023 March | 88 | 25 | 113 |
| 2023 February | 90 | 18 | 108 |
| 2023 January | 107 | 44 | 151 |
| 2022 December | 91 | 41 | 132 |
| 2022 November | 88 | 32 | 120 |
| 2022 October | 82 | 35 | 117 |
| 2022 September | 56 | 27 | 83 |
| 2022 August | 75 | 46 | 121 |
| 2022 July | 55 | 44 | 99 |
| 2022 June | 65 | 26 | 91 |
| 2022 May | 82 | 39 | 121 |
| 2022 April | 65 | 32 | 97 |
| 2022 March | 87 | 40 | 127 |
| 2022 February | 79 | 33 | 112 |
| 2022 January | 110 | 47 | 157 |
| 2021 December | 66 | 42 | 108 |
| 2021 November | 85 | 45 | 130 |
| 2021 October | 85 | 52 | 137 |
| 2021 September | 60 | 50 | 110 |
| 2021 August | 50 | 52 | 102 |
| 2021 July | 67 | 42 | 109 |
| 2021 June | 48 | 41 | 89 |
| 2021 May | 69 | 28 | 97 |
| 2021 April | 192 | 52 | 244 |
| 2021 March | 125 | 30 | 155 |
| 2021 February | 78 | 24 | 102 |
| 2021 January | 91 | 17 | 108 |
| 2020 December | 77 | 28 | 105 |
| 2020 November | 63 | 15 | 78 |
| 2020 October | 59 | 19 | 78 |
| 2020 September | 63 | 21 | 84 |
| 2020 August | 68 | 10 | 78 |
| 2020 July | 67 | 16 | 83 |
| 2020 June | 56 | 12 | 68 |
| 2020 May | 67 | 21 | 88 |
| 2020 April | 34 | 14 | 48 |
| 2020 March | 52 | 19 | 71 |
| 2020 February | 50 | 15 | 65 |
| 2020 January | 33 | 14 | 47 |
| 2019 December | 68 | 19 | 87 |
| 2019 November | 35 | 10 | 45 |
| 2019 October | 39 | 6 | 45 |
| 2019 September | 34 | 18 | 52 |
| 2019 August | 56 | 23 | 79 |
| 2019 July | 43 | 43 | 86 |
| 2019 June | 41 | 17 | 58 |
| 2019 May | 92 | 27 | 119 |
| 2019 April | 109 | 44 | 153 |
| 2019 March | 33 | 15 | 48 |
| 2019 February | 39 | 19 | 58 |
| 2019 January | 38 | 23 | 61 |
| 2018 December | 36 | 22 | 58 |
| 2018 November | 70 | 30 | 100 |
| 2018 October | 81 | 28 | 109 |
| 2018 September | 35 | 19 | 54 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 25 | 0 | 25 |
| 2018 March | 49 | 0 | 49 |
| 2018 February | 30 | 0 | 30 |
| 2018 January | 39 | 0 | 39 |
| 2017 December | 22 | 0 | 22 |
| 2017 November | 11 | 0 | 11 |
| 2017 October | 9 | 0 | 9 |
| 2017 September | 13 | 0 | 13 |
| 2017 August | 14 | 0 | 14 |
| 2017 July | 22 | 1 | 23 |
| 2017 June | 18 | 9 | 27 |
| 2017 May | 26 | 6 | 32 |
| 2017 April | 16 | 6 | 22 |
| 2017 March | 7 | 4 | 11 |
| 2017 February | 6 | 3 | 9 |
| 2017 January | 6 | 7 | 13 |
| 2016 December | 31 | 2 | 33 |
| 2016 November | 35 | 1 | 36 |
| 2016 October | 34 | 4 | 38 |
| 2016 September | 35 | 5 | 40 |
| 2016 August | 16 | 2 | 18 |
| 2016 July | 8 | 0 | 8 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 5 | 16 | 21 |
| 2015 November | 2 | 6 | 8 |
| 2015 October | 9 | 10 | 19 |
| 2015 September | 1 | 19 | 20 |
| 2015 August | 2 | 18 | 20 |
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