Volume 13 Supplement 1

8th International Congress of Familial Mediterranean Fever and Systemic Autoinflammatory Diseases

Open Access

MAGIC- is it for real?

  • L Damian1,
  • M Velcherean2,
  • M Andrei3,
  • I Felea1,
  • P Vele3 and
  • S Rednic1, 3
Pediatric Rheumatology201513(Suppl 1):P156

https://doi.org/10.1186/1546-0096-13-S1-P156

Published: 28 September 2015

Question

MAGIC syndrome, an acronym for mouth and genital ulcers with inflammed cartilage, is a rare condition described in 1985 [1]. About 20 cases have been reported [2], and its existence is challenged, as it could be just a mere association of Bechet's disease (BD) with relapsing polychondritis (RP) [3]. Other authors, however, consider it a distinct entity with higher risk of aortic aneurysms [4]. We tried to find out whether this syndrome is a true nosologic entity.

Methods

We retrospectively reviewed our tertiary referral centre's database from 2000 to 2015 in order to identify the cases of RP and BD. All patients fulfilled the International Criteria for BD [5] and the Damiani-Levine criteria for RP [6].

Results

Three cases have been identified, all diagnosed with MAGIC's syndrome since the first presentation. No other case evolved into MAGIC after an initial diagnosis of RP or BD. Hematological screening was negative in all patients; one had gastrointestinal vasculitis and another one panniculitis. No one in our series had eye or CNS involvement. Aortic aneurysms were absent (as yet) in the 2 patients searched for. Azathioprine, colchicine and corticotherapy were employed effectively in all patients.
Table 1

Clinical features of MAGIC patients in our series

Case

Sex, age

Clinical features

Therapy

Aortic involvement

Outcome

1

F, 63

oral aphtae since youth; genital aphtae, deep vein thrombosis, migratory seronegative polyarthritis, reccurent bilateral auricular chondritis, wheesing

CS, AZA,Col

NK

Lost to follow-up (after 2 years)

2

F, 35

bipolar aphtae, asymmetric sacroiliitis, acneiform rash, intermittent seronegative polyarthritis, gastrointestinal involvement, bilateral auricular and nasal chondritisANA positive, dsDNA negative

CS, AZA,Col

No/NK

Lost to follow-up (after 3 years- emigrated)

3

M, 2

bipolar aphtae, pseudofolliculitis, erythema nodosum, arthritis, panniculitis, recurrent auricular chondritis, nasal chondritis, positive cartilage biopsy

CS, AZA,Col

No

Rare chondritis flares

CS=corticosteroids, Col=colchicine, AZA=azathioprine

Conclusion

RP and BD have overlapping features and may share pathogenetic mechanisms. The same time of onset of the main MAGIC clinical features could favour the classification of the disease as distinct from RP and BD alone. However, in our small and incompletely followed-up series aortic aneurysms were not seen, like in other MAGIC cases reported. An aortic follow-up is nevertheless advisable, as in any RP.

Authors’ Affiliations

(1)
Emergency Clinical County Hospital Cluj
(2)
Emergency County Hospital Deva
(3)
“Iuliu Hatieganu” University of Medicne and Pharmacy Cluj

References

  1. Firestein GS, Gruber E, Weisman MH, Zvaifler NJ, Barber J, O'Duffy JD: Mouth and genital ulcers with inflamed cartilage: MAGIC syndrome. Am J Med. 1985, 79 (1): 65-72. 10.1016/0002-9343(85)90547-9.View ArticlePubMedGoogle Scholar
  2. Wajed J, Kiely P: 19. Could it be Magic?. Rheumatology. 2011, 50 (Suppl 3): iii43-iii50.Google Scholar
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  4. Hidalgo-Tenorio C, Sabio-Sanchez JM, Linares PJ, Salmeron LM, Ros-die E, Jimenez-Alonso J: Magic syndrome and true aortic aneurysm. Clin Rheumatol. 2008, 27 (1): 115-117.View ArticlePubMedGoogle Scholar
  5. Kronborg C, Mahar PD, Kelly R: Should we keep changing the diagnostic criteria for Behcet's disease?. Dermatology. 2014, 228 (1): 1-4. 10.1159/000355481.View ArticlePubMedGoogle Scholar
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Copyright

© Damian et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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