Cachafeiro-Vilar Antonio, García-Padilla Carlos, Reyes Edgardo, Hernández-Molina Gabriela
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, 14000 Mexico City, Mexico.
Joint Bone Spine. 2007 Jan;74(1):107-9. doi: 10.1016/j.jbspin.2006.02.014. Epub 2006 Dec 4.
We describe a 37-year-old Mexican man with incapacitating polyarticular arthritis secondary to Mycobacterium bovis infection. A dermatologist diagnosed psoriasis two years before admission. One year later due to symmetric ankle and knee arthritis, he was treated with three doses of etanercept. The arthritis extended to the carpus and metacarpophalangeal joints. Multifocal dactylitis and a left ankle periarticular abscess were documented. Concomitantly he developed fever, cough, and adenopathies. Ankle MRI showed osteomyelitis of the calcaneous with a posterior abscess. A CT-body scan documented mild pleural effusion that corresponded to an exudate. An ankle aspiration yielded a caseous fluid with acid-fast bacilli. Knee and ankle synovial biopsies documented a granulomatous synovitis. A lymph node biopsy showed granulomas with caseous necrosis. After 1 month, Mycobacterium bovis was isolated from these tissues. Antituberculous regimen was started with satisfactory response. Although largely eradicated, bovine tuberculosis still occurs. Nevertheless, the clinical presentation as polyarthritis is very uncommon and represents a diagnostic challenge.
我们描述了一名37岁的墨西哥男子，他因牛分枝杆菌感染继发严重的多关节关节炎。入院前两年，皮肤科医生诊断为银屑病。一年后，由于双侧踝关节和膝关节关节炎，他接受了三剂依那西普治疗。关节炎扩展至腕关节和掌指关节。记录有多灶性指（趾）炎和左踝关节周围脓肿。同时，他出现发热、咳嗽和淋巴结肿大。踝关节MRI显示跟骨骨髓炎伴后侧脓肿。胸部CT扫描显示轻度胸腔积液，为渗出液。踝关节穿刺抽出含有抗酸杆菌的干酪样液体。膝关节和踝关节滑膜活检显示肉芽肿性滑膜炎。淋巴结活检显示有干酪样坏死的肉芽肿。1个月后，从这些组织中分离出牛分枝杆菌。开始抗结核治疗，反应良好。尽管牛结核病在很大程度上已被根除，但仍有发生。然而，以多关节炎为临床表现非常罕见，是一个诊断难题。
