Azuma Naoto, Kuno Hideki, Imamura Fumiaki, Fukunishi Shigeo, Okabe Mika, Kitano Masayasu, Hashimoto Naoaki, Kanda Chieri, Nishioka Aki, Sekiguchi Masahiro, Kuroiwa Takanori, Matsui Kiyoshi, Iwasaki Tsuyoshi, Yoshiya Shinichi, Sano Hajime
Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine.
Nihon Rinsho Meneki Gakkai Kaishi. 2008 Apr;31(2):113-8. doi: 10.2177/jsci.31.113.
We herein report a case of spontaneous rupture of Achilles tendon in a 51-year-old man with refractory Reiter's syndrome. On the diagnosis in November, 2006, physical examinations and MR images showed a remarkable inflammation at the calcaneal insertion area of Achilles tendon. He required aggressive treatments with nonsteroidal anti-inflammatory drug (NSAID), oral prednisolone 30 mg daily and methotrexate (8 mg weekly) to control the disease. Two months later, the Achilles tendon ruptured at its insertion point. This ruptured lesion of Achilles tendon was an unusual site compared to previous reports. Histological findings in the ruptured lesion of Achilles tendon revealed the existence of granulomatous lesion consisted of severe infiltration of fibroblasts and vessels proliferation beside tendon. These findings suggest a prolonged inflammation. Although it is widely accepted that Reiter's syndrome is associated with enthesis, especially at the attachment of Achilles tendon to calcaneum, there have been only two reports of Achilles tendon rupture associated with Reiter's syndrome. The possible cause of the Achilles tendon rupture in this patient might be due to the weakened strength of the Achilles tendon by the prolonged and severe enthesis of Achilles tendon near the insertion lesion.
我们在此报告一例51岁患有难治性赖特综合征的男性跟腱自发性断裂病例。2006年11月确诊时，体格检查和磁共振成像显示跟腱在跟骨附着区域有明显炎症。他需要用非甾体抗炎药（NSAID）、每日口服30毫克泼尼松龙和甲氨蝶呤（每周8毫克）进行积极治疗以控制病情。两个月后，跟腱在其附着点处断裂。与先前报道相比，该跟腱断裂部位不同寻常。跟腱断裂处的组织学检查结果显示存在肉芽肿病变，由肌腱旁成纤维细胞的严重浸润和血管增生组成。这些发现提示炎症持续时间较长。尽管普遍认为赖特综合征与起止点病有关，尤其是在跟腱附着于跟骨处，但仅有两篇关于赖特综合征相关跟腱断裂的报道。该患者跟腱断裂的可能原因可能是由于跟腱在附着点病变附近长期严重的起止点病导致跟腱强度减弱。
