<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0035-0052</journal-id>
<journal-title><![CDATA[Revista mexicana de pediatría]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. mex. pediatr.]]></abbrev-journal-title>
<issn>0035-0052</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Mexicana de Pediatría A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0035-00522019000200065</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Artritis idiopática juvenil de inicio sistémico, un reto diagnóstico: reporte de caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Juvenile idiopathic arthritis of systemic onset, a diagnostic challenge: Case report]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valencia-Palacio]]></surname>
<given-names><![CDATA[Eduar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Uribe-Castrillón]]></surname>
<given-names><![CDATA[Lina María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gallo-Sáenz]]></surname>
<given-names><![CDATA[Claudia Marcela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zapata-Catellanos]]></surname>
<given-names><![CDATA[Aura Ligia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gallego-González]]></surname>
<given-names><![CDATA[Daniel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Pontificia Bolivariana  ]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Clínica Universitaria Bolivariana  ]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Pontificia Bolivariana  ]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2019</year>
</pub-date>
<volume>86</volume>
<numero>2</numero>
<fpage>65</fpage>
<lpage>70</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0035-00522019000200065&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0035-00522019000200065&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0035-00522019000200065&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción: La artritis idiopática juvenil (AIJ) es la primera causa de artritis crónica en la niñez; sin embargo, su diagnóstico puede ser difícil. El presente artículo tiene como objetivo describir el proceso diagnóstico de un paciente con AIJ sistémica.  Presentación del caso:  Paciente masculino de 14 meses de edad, con cuadro de 15 días de evolución con fiebre diaria hasta de 40o C, refractaria al manejo antipirético, asociada a irritabilidad e hiporexia. Recibió antimicrobianos por sospecha de bacteremia oculta. Cinco días después se agregó eritema polimorfo, por lo que se consideró enfermedad de Kawasaki, recibiendo gammaglobulina, pero sin respuesta clínica. A los 24 días de evolución persistía la fiebre y artritis; en resonancia magnética se detectó derrame intraarticular en ambas rodillas y cadera izquierda, sin datos de osteomielitis. En líquido sinovial de la rodilla derecha se detectó aumento de polimorfonucleares, por lo que se piensa en artritis séptica, iniciando vancomicina. Fue enviado a otro hospital por persistencia del cuadro; se corroboró fiebre y exantema maculopapular generalizado no pruriginoso, de predominio en tronco. Hasta los 40 días de evolución se confirmó el diagnóstico de AIJ sistémica y se inició el manejo con esteroides sistémicos. Una semana después, no hubo modificación del cuadro clínico agregando tocilizumab y metotrexato, con lo cual hubo remisión de fiebre y exantema, con mejoría de la sintomatología articular.  Conclusión:  La AIJ es una enfermedad que comparte signos y síntomas clínicos con diferentes patologías. En general, el diagnóstico en niños pequeños es de exclusión debido a lo inespecífico del cuadro y a la falta de estudios de laboratorio o imagenológicos que la confirmen.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction: Juvenile idiopathic arthritis (JIA) is the leading cause of chronic arthritis in childhood; however, its diagnosis can be difficult. This article aims to describe the diagnostic process from a patient with systemic JIA.  Case presentation: Male patient of 14 months of age, with 15 days of daily fever up to 40oC; the fever was refractory to antipyretic management and was associated with irritability and hyporexia. He received antimicrobials on suspicion of hidden bacteremia. Five days later, polymorphic erythema was added, so it was considered Kawasaki disease, receiving gammaglobulin but without clinical response. After 24 days of evolution, fever and arthritis persisted; Magnetic resonance imaging revealed intraarticular effusion in both knees and left hip, with no evidence of osteomyelitis. In synovial fluid of the right knee an increase of polymorphonuclear cells was detected, reason why septic arthritis was considered, initiating vancomycin. He was sent to another hospital because of the persistence of the condition; it was confirmed the fever and the maculopapular, generalized, not pruritic exanthema, which predominated on the trunk. Up to 40 days of evolution, the diagnosis of systemic JIA was confirmed and treatment with systemic steroids was initiated. One week later, tocilizumab and methotrexate were added because the symptoms remained unchanged. With this treatment the remission of fever and exanthema was achieved, as well as improvement of the joint symptoms.  Conclusion:  JIA is a disease that shares clinical signs and symptoms with different diseases. In general, due to the non-specific nature of the clinical picture and the lack of laboratory or imaging studies to confirm it, the diagnosis in young children is made by exclusion.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Fiebre persistente]]></kwd>
<kwd lng="es"><![CDATA[artritis]]></kwd>
<kwd lng="es"><![CDATA[artritis idiopática juvenil sistémica]]></kwd>
<kwd lng="en"><![CDATA[Persistent fever]]></kwd>
<kwd lng="en"><![CDATA[arthritis]]></kwd>
<kwd lng="en"><![CDATA[systemic onset juvenile idiopathic arthritis]]></kwd>
</kwd-group>
</article-meta>
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