Kow A W C, Lee K B L, Wong Y S
Department of Orthopaedic Surgery, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
Singapore Med J. 2005 May;46(5):233-5.
A patient with musculoskeletal melioidosis masquerading as diabetic amyotrophy is described. A 43-year-old man presented with left thigh pain, fever, malaise and loss of weight. He had diabetes mellitus for six years. He was initially diagnosed with diabetic amyotrophy and was treated conservatively. Recurrence of symptoms prompted further investigations which revealed melioidosis of the left femur. Magnetic resonance imaging showed an enhancing subperiosteal collection. The diagnosis was confirmed by open biopsy and tissue culture. Acute treatment consisted of intravenous ceftazidime for 24 days and oral cotrimoxazole. The patient showed marked improvement clinically and biochemically. He was discharged with oral doxycycline and cotrimoxazole for three months. This disease is eminently treatable, but can be a diagnostic challenge when it presents in an uncommon site.
本文描述了一名伪装成糖尿病性肌萎缩的骨骼肌肉型类鼻疽患者。一名43岁男性，出现左大腿疼痛、发热、全身不适和体重减轻症状。他患有糖尿病六年。最初被诊断为糖尿病性肌萎缩并接受了保守治疗。症状复发促使进一步检查，结果显示左股骨类鼻疽。磁共振成像显示骨膜下有强化灶。通过开放性活检和组织培养确诊。急性治疗包括静脉注射头孢他啶24天和口服复方新诺明。患者在临床和生化指标上均有明显改善。出院时口服强力霉素和复方新诺明三个月。这种疾病是完全可以治疗的，但当它出现在不常见的部位时，可能会带来诊断挑战。
