Iveson J M, McDougall A C, Leathem A J, Harris H J
Br Med J. 1975 Sep 13;3(5984):619-21. doi: 10.1136/bmj.3.5984.619.
A Pakistani man aged 19 years was admitted to a rheumatological unit in the United Kingdom with acute widespread polyarthritis accompanied by night sweats and fever. Preliminary examination suggested Reiter's disease, but further investigation showed acute glomerulonephritis with uraemia. The possibility of periarteritis nodosa, and the prominence of muscle tenderness in the legs, led to biopsies of striated muscle and skin, in both of which were changes typical of lepromatous leprosy, with many Mycobacterium leprae on Ziehl-Neelsen staining. Serum showed IgG-IgM cryoglobulinaemia without antiglobulin activity, and in the recovery phase renal biopsy showed a resolving proliferative glomerulonephritis with linear IgG and IgM immunofluorescence and granular deposits of C3. Clinical signs subsided rapidly under steroid treatment and subsequent progress on anti-leprosy drugs was uneventful. The term erythema nodosum leprosum is inadequate and misleading as a title for a common and important immune-complex reaction of lepromatous leprosy, in which numerous body systems may be involved.
一名19岁的巴基斯坦男子因急性广泛性多关节炎伴盗汗和发热，入住英国一家风湿病科病房。初步检查提示赖特综合征，但进一步检查显示为急性肾小球肾炎伴尿毒症。由于结节性多动脉炎的可能性以及腿部肌肉压痛明显，遂对横纹肌和皮肤进行活检，两者均显示为瘤型麻风的典型变化，齐-尼氏染色可见大量麻风杆菌。血清显示IgG-IgM冷球蛋白血症但无抗球蛋白活性，恢复期肾活检显示增生性肾小球肾炎逐渐消退，有线性IgG和IgM免疫荧光以及C3颗粒沉积。在类固醇治疗下临床症状迅速缓解，随后使用抗麻风药物治疗过程顺利。“麻风结节性红斑”作为瘤型麻风常见且重要的免疫复合物反应的名称并不恰当且具有误导性，因为该反应可能累及众多身体系统。
