Atypical debut manifestations in juvenile idiopathic arthritis

Vol. 54 No. 3 Suppl., 2013
This supplement was not sponsored by Outside Organizations.


Dalia Dop, Carmen-Elena Niculescu, Ligia Stanescu, D. Niculescu, A. Stepan

Considering that destructive articular lesions may occur in the first stages of the illness, it is difficult but necessary to establish a diagnosis of Juvenile Idiopathic Arthritis (JIA) in due time. The authors present the case of a 9-year-old girl admitted to the Pediatrics Clinic of the "Filantropia" Municipal Hospital in Craiova, Romania, on November 26, 2002, for bilateral pain in the tarsometatarsal and carpometatarsal joints that had begun approximately four weeks before. After the clinical examination and paraclinical investigations, a diagnosis of unspecified arthritis is established and the adequate treatment is begun. Two months later, the patient returns to the clinic with bilateral knee pain and swelling. The results of laboratory tests indicate the persistence of anemia and of the inflammatory syndrome. The diagnosis of JIA is established. The evolution of the patient is unfavorable, both from a clinical point of view (a large number of articulations affected, a persistent rash, hepatomegaly) and a paraclinical one (increased acute phase reactants and radiological changes occurring two years after the onset of the illness).

Corresponding author: Dalia Dop, MD; e-mail:

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M. Cantin, G. M. Fonseca

Dens invaginatus (DI) is a dental anomaly originated from invagination of the enamel organ into the dental papilla, during odontogenesis. DI may be associated with other abnormalities such as dysmorphic mesiodens, and this unusual condition may be detected by chance on the conventional radiography. However, the three-dimensional nature and the exact morphological patterns of DI are impossible to appreciate from this method. We present a morphological study of impacted mesiodens in a 9-year-old girl, which the three coronal invaginations were detected only by Cone-Beam Computed Tomography (CBCT) in the pre-surgical examination. CBCT, radiographic and microscopic reproductions allow transfer of images to facilitate cooperation of working groups, examination as well as for teaching purposes.

Corresponding author: Gabriel M. Fonseca, DDS, PhD; e-mail:

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