Abouzahir Ali, El Maghraoui Abdellah, Tabache Fatima, Bezza Ahmed, Chaari Jilali, Ghafir Driss, Ohayon Victor, Archane Moulay-Idriss
Service de Médecine B, Hôpital Militaire d'Instruction Mohamed-V, Rabat, Maroc, France.
Ann Med Interne (Paris). 2002 Oct;153(6):407-10.
Ankylosing spondylitis is a very uncommon finding in patients with sarcoidosis. Thirteen cases have been reported in the literature. We report a new case. Observation. - A 40-year-old man had inflammatory low back pain since 1983 which formerly responded to nonsteroidal inflammatory drugs (NSAIDs). He developed dyspnea and skin rash in 1993. Physical exam found cervical and lumbar spine stiffness and violaceous and circular lesions on the forehead, nose and right cheek. Laboratory tests showed: ESR at 50 mm, increased serum angiotensin-1-converting enzyme, and negative HLA B27. X-rays showed sacroiliac ankylosis, cervical and lumbar syndesmophytes and cervical facet joint ankylosis. The plain chest x-ray showed an interstitial syndrome. Chest CT scan showed mediastinal adenopathies. Skin biopsy disclosed non-caseating epitheliod and giant-cell granuloma. Outcome was good with steroid therapy but back pain was only improved by NSAIDs.
强直性脊柱炎在结节病患者中是一种非常罕见的表现。文献中已报道了13例。我们报告1例新病例。病例观察。——一名40岁男性自1983年起出现炎性下背痛，此前对非甾体类抗炎药（NSAIDs）有反应。1993年他出现呼吸困难和皮疹。体格检查发现颈椎和腰椎僵硬，前额、鼻子和右脸颊有紫色圆形病变。实验室检查显示：血沉50mm，血清血管紧张素转换酶升高，HLA B27阴性。X线显示骶髂关节强直、颈椎和腰椎骨桥形成以及颈椎小关节强直。胸部平片显示间质性综合征。胸部CT扫描显示纵隔淋巴结肿大。皮肤活检显示非干酪样上皮样和巨细胞肉芽肿。类固醇治疗效果良好，但背痛仅通过NSAIDs得到改善。
——这种关联引发了一个诊断问题，因为结节病累及脊柱可酷似强直性脊柱炎。这也提示了两种疾病之间存在病理生理联系的假说。
