Mian Ayesa N, Farney Alan C, Mendley Susan R
University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD, USA.
Am J Transplant. 2005 Jan;5(1):183-8. doi: 10.1111/j.1600-6143.2004.00634.x.
Septic arthritis (SA) typically occurs in young children, often from Staphylococcus. With chronic immunosuppression, however, pathogens may be atypical. A 15-year-old African-American female developed Mycoplasma hominis SA in her right hip 2 months following cadaveric renal transplant (Tx). Her presentation was subtle and indolent, without fever or leukocytosis. Although reported in adult Tx recipients, M. hominis infections have not been described in pediatric recipients. Early immunosuppression (basiliximab, prednisone, tacrolimus, mycophenolate mofetil and Thymoglobulin) may have increased her susceptibility to M. hominis. Optimal therapy for M. hominis SA is not well established and relapses occur. This patient underwent joint incision and drainage, treatment for 8 weeks with doxycycline and levofloxacin guided by in vitro sensitivities, and a reduction in immunosuppression. She has been free of ongoing infection for 3 years with stable graft function (Cr 1.1 mg/dL) on moderate immunosuppression with prednisone, tacrolimus and MMF.
化脓性关节炎（SA）通常发生在幼儿身上，常见病原体往往是葡萄球菌。然而，在慢性免疫抑制的情况下，病原体可能不典型。一名15岁的非裔美国女性在尸体肾移植（Tx）后2个月，右侧髋关节发生人型支原体SA。她的症状不明显且进展缓慢，没有发热或白细胞增多。虽然人型支原体感染在成年肾移植受者中有报道，但在儿科肾移植受者中尚未见描述。早期免疫抑制治疗（使用巴利昔单抗、泼尼松、他克莫司、霉酚酸酯和抗胸腺细胞球蛋白）可能增加了她对人型支原体的易感性。人型支原体SA的最佳治疗方案尚未明确，且会出现复发情况。该患者接受了关节切开引流术，根据体外药敏试验结果使用强力霉素和左氧氟沙星治疗8周，并减少了免疫抑制治疗。在使用泼尼松、他克莫司和霉酚酸酯进行中度免疫抑制治疗的情况下，她已3年没有持续感染，移植肾功能稳定（血肌酐1.1mg/dL）。
