Systemic juvenile idiopathic arthritis, with tinea capitis and peripheral eosinophilia: a case report

Systemic juvenile idiopathic arthritis (SJIA) is a unique subtype of juvenile idiopathic arthritis (JIA) with very special clinical manifestations, complications, and management options. The simultaneous presentation of tinea capitis and eosinophilia has not been reported in the context of Systemic Juvenile Idiopathic Arthritis before.

A 5-year-old Sudanese boy presented with fever and bilateral ankle arthritis in a background of extensive scalp lesions, which were scaly, itchy, and associated with hair loss. On examination: his weight was on the fifth percentile. There was cervical lymphadenopathy, hepatomegaly, and signs of bilateral ankle arthritis. Complete blood counts revealed leucocytosis, thrombocytosis, mild eosinophilia, and microcytic hypochromic anemia. Anti-dsDNA was positive with equivocal ANA profile, CRP was 34.4 mg/l, and LDH was very high. The patient received antibiotics, systemic antifungal, corticosteroids, hydroxychloroquine for which he achieved good results.

These results support the diagnosis of SJIA in a background of a tinea capitis with mild eosinophilia. Several case reports described extensive dermatophytosis in the background of other autoimmune diseases. The etiology of the eosinophilia was mysterious.

Physicians should be alert to the presentation of systemic JIA. The association between SJIA, tinea capitis, and eosinophilia remained largely mysterious, and multicenter studies are needed to explore this further.