Phalangeal microgeodic syndrome: a paediatric case series

Area of Science:

• Pediatric Rheumatology
• Radiology
• Infectious Disease Epidemiology

Background:

• Phalangeal microgeodic syndrome (PMS) is a rare pediatric condition affecting the digits with unknown etiology.
• The study occurred during the second peak of the COVID-19 pandemic in the UK, observing a cluster of affected children.

Purpose of the Study:

• To describe the clinical and radiological characteristics of PMS in a pediatric cohort.
• To investigate potential associations between PMS and the COVID-19 pandemic.

Main Methods:

• Case series analysis of five children presenting with phalangeal swelling and erythema.
• Clinical evaluation, laboratory investigations, X-rays, and Magnetic Resonance Imaging (MRI) were performed.
• Rheumatological work-up was conducted for all participants.

Main Results:

• Four children had hand involvement, one had foot involvement; ages ranged from 10.4 to 16.6 years.
• X-rays showed microgeodes and bone resorption in some cases, but MRI revealed more extensive marrow edema, soft tissue swelling, and cortical erosions.
• MRI findings were more pathognomonic in the acute clinical context.

Conclusions:

• Phalangeal microgeodic syndrome diagnosis benefits from MRI due to its sensitivity to bone marrow edema and soft tissue abnormalities, surpassing plain X-rays.
• The temporal association with the COVID-19 pandemic suggests a potential role for COVID-related thrombophilia or immune-mediated vasculopathy as triggers for PMS.
• COVID-19 vasculopathy may be a previously unrecognized cause of PMS.