Polnau U, Braun M G, van den Boom H, Becker-Capeller D
Internistisch-rheumatologische Abteilung, Seehospital Sahlenburg, Nordheim-Stiftung, Nordheimstrasse 27455 Cuxhaven.
Z Rheumatol. 2001 Feb;60(1):41-6. doi: 10.1007/s003930170096.
We report about a patient with polyarticular rheumatoid arthritis taking methotrexat and 5 mg prednisolone who developed in the course of a RA flare a septic arthritis in the right shoulder. Listeria monocytogenes could be identified as the causative bacteria. Clinically, the Listeria-induced septic arthritis could not be differentiated from rheumatoid arthritis; fever was not present. The synovial analysis showed a granulocytic effusion with 19,000 cells/ml; there was no microbiological growth within the first 24 hours. Only the low glucose level indicated a possible septic arthritis. After 48 hours, gram-positive bacterial growth was evident and Listeria monocytogenes could be isolated after 72 hours. Therapy was initiated by antibiotic treatment and arthrotomy with synovectomy followed by extensive irrigation which proved effective in bacterial elimination but joint destruction resulted. During the whole course, Listeria antibodies were negative and proved to be too insensitive. The incidence of Listeria-induced arthritis is very low; a review of the literature revealed only 24 reported cases. It occurs primarily in patients with rheumatic diseases under immunosuppression and in prosthetic joints. The diagnosis is based on cultural detection. It is important to cultivate synovial effusions for longer than 24 hours in order to identify Listeria. This is of relevance since Listeria serology is not sensitive.
我们报告了一名患有多关节类风湿性关节炎的患者，该患者正在服用甲氨蝶呤和5毫克泼尼松龙，在类风湿性关节炎病情加重期间，右肩部发生了化脓性关节炎。可确定单核细胞增生李斯特菌为致病菌。临床上，李斯特菌引起的化脓性关节炎无法与类风湿性关节炎区分开来；患者没有发热。滑膜分析显示粒细胞渗出液，细胞计数为19,000个/毫升；在最初24小时内没有微生物生长。只有低葡萄糖水平表明可能存在化脓性关节炎。48小时后，革兰氏阳性菌生长明显，72小时后分离出单核细胞增生李斯特菌。治疗首先采用抗生素治疗和关节切开术并进行滑膜切除术，随后进行广泛冲洗，这证明对消除细菌有效，但导致了关节破坏。在整个病程中，李斯特菌抗体呈阴性，且被证明过于不敏感。李斯特菌引起的关节炎发病率非常低；文献综述仅发现24例报道病例。它主要发生在免疫抑制下的风湿性疾病患者和人工关节患者中。诊断基于培养检测。为了鉴定李斯特菌，对滑膜积液进行超过24小时的培养很重要。这很关键，因为李斯特菌血清学不敏感。
