COVID-19 musculoskeletal involvement in children

Abstract

Since the early phases of the COVID-19 pandemic, it has become clear that children are affected by mild respiratory symptoms rather than the critical pneumonia typical in adults. Nevertheless, it took longer to understand that pediatric patients with SARS-COV2 may develop a severe multisystem inflammatory response (a.k.a. multisystem inflammatory syndrome in children (MIS-C)), which can include musculoskeletal symptoms, and/or arthritis and myositis independently from MIS-C. Diagnostic imaging significantly contributed to the assessment of pulmonary disease due to COVID-19 but it has been rarely applied to evaluate musculoskeletal involvement in children with or without previous rheumatic diseases. Despite the paucity of radiological literature, muscle edema at magnetic resonance and synovitis at ultrasound have been described. Further use of diagnostic imaging for children with articular and muscular symptoms due to COVID-19 is strongly encouraged.

Keywords: COVID-19; arthritis; children; musculoskeletal system; myositis.

Figure 1

Axial (A) and coronal post-contrast fat-sat T1W (B) images of a 12-year-old girl with COVID-19 infection complaining of back pain, well demonstrating myositis of the paravertebral muscle [yellow arrows in (A)] and bilateral enthesitis of the iliolumbar ligaments [red asterisks in (B)].

Figure 2

A 10-year-old boy with left hip pain 2 weeks after a mild respiratory COVID-19 infection with negative radiographs (A) but joint effusion at ultrasound (B) then confirmed at the MR [yellow arrow on the axial T2W turbo spin echo sequence in (C)] which also demonstrated synovial enhancement after contrast medium injection [yellow arrow in (D)].