Bamboo nodes in 6-year-old girl with mixed connective tissue disease

Abstract

We　report　on　a　case　of　pediatric　MCTD　accompanied　by　bamboo　nodes．　A　6-year-old　girl　admitted　to our　hospital　complaining　fatigue, fever　and　purpura．　Blood　examination　showed　low　platelet　count，high　index of　anti-nuclear　antibody　and　anti-RNP　antibody．　At　first，she　was　diagnosed　as　idiopathic　thrombocytopenic purpura　and　she　was　treated　with　prednisolone．　Platelet　count　elevated　by　prednisolone，but　she　complained arthralgia，erythema　of　cheeks，and　hoarseness　after　the　reduction　of　prednisolone．Raynaud　phenomenon　was also　demonstrated　by　thermography．Thereafter，her　diagnosis　was　changed　to　MCTD　and　she　was　treated　with prednisolone　and　MMF　in　good　contro1．Bamboo　nodes　show　a　transversal　cream－yellow　band　lesion　at　the midpoint　of　the　upper　surface　of　vocal　fold．They　are　named　bamboo　nodes　because　their　appearance　resembles bamboo　and　its　nodes．These　unique　lesions　are　known　as　specific　lesions　related　to　autoimmune　diseases．It is reported that　there　is　a　good　correlation　between　the　manifestations　of these　lesions　with　primary　disease　activity， and　in　some　cases，hoarseness　due　to　this　lesion　may　be　first　and　only　subjective　symptom　of　autoimmune disease．The　incidence　of the　lesion　is　not　clear，and　there　is　no　report　on　pediatric　case　to　our　knowledge.