Benthien Jan Philipp, Delling G, Rüther W
Orthopädische Klinik, Rheumaklinik Bad Bramstedt, Oskar-Alexander-Str. 26, 24576 Bad Bramstedt, Germany.
Z Rheumatol. 2003 Aug;62(4):402-5. doi: 10.1007/s00393-003-0471-5.
A 66-year old patient sustained a non-traumatic rupture of her left achilles tendon. She suffered from Sjögren's syndrome which occurred in conjunction with a systemic vasculitis, and recurrent episcleritis. The combination of Sjögren's syndrome and systemic vasculitis is well known. Subsequently, she was treated with high-dose systemic steroids over a period of 2 years. In order to reduce the amount of steroids due to preexisting severe osteoporosis and thoracic vertebral fractures, her medication was changed to cyclophosphamide shortly before her injury. Intraoperatively, a granuloma was discovered at the site of the rupture. This granuloma had infiltrated most of the achilles tendon at this site and virtually replaced viable tendon tissue. Originally, the rupture was supposedly due to the high dose steroids. This theory had to be revised according to the intraoperative findings. Following excision of the granuloma and operative treatment of the achilles tendon rupture, the continuity of the tendon could be completely restored. A MRI scan 3 months after the procedure demonstrated a completely healed Achilles tendon. Spontaneous achilles tendon rupture due to a granuloma in patients with vasculitis seems to be a rare event. However, tendon ruptures in combination with systemic lupus erythematodes have been described. Mostly, these events are attributed to long term application of steroids. Spontaneous rupture in combination with high dose treatment of steroids seems to be an underestimated problem.
一名66岁患者左侧跟腱发生非创伤性断裂。她患有干燥综合征，同时伴有系统性血管炎和复发性巩膜炎。干燥综合征与系统性血管炎的合并情况是众所周知的。随后，她接受了为期2年的大剂量全身类固醇治疗。为了因既有严重骨质疏松和胸椎骨折而减少类固醇用量，在受伤前不久她的药物改为环磷酰胺。术中，在断裂部位发现一个肉芽肿。这个肉芽肿浸润了该部位大部分跟腱，几乎取代了存活的肌腱组织。最初，断裂被认为是由于高剂量类固醇所致。根据术中发现，这一理论不得不被修正。切除肉芽肿并对跟腱断裂进行手术治疗后，肌腱的连续性得以完全恢复。术后3个月的MRI扫描显示跟腱完全愈合。血管炎患者因肉芽肿导致的自发性跟腱断裂似乎是一种罕见事件。然而，已有跟腱断裂与系统性红斑狼疮合并的描述。大多数情况下，这些事件归因于长期应用类固醇。与高剂量类固醇治疗相关的自发性断裂似乎是一个被低估的问题。
