Ono Hirohiko, Suzuki Naoki, Mizuno Hideki, Tateyama Maki, Aoki Masashi, Itoyama Yasuto
Department of Neurology, Tohoku University School of Medicine.
Rinsho Shinkeigaku. 2009 Feb-Mar;49(2-3):119-22. doi: 10.5692/clinicalneurol.49.119.
A 35-year-old man suffered from myalgia and joint pain on walking for 5 months. Physical and neurological examinations revealed dermal sclerosis, skin swelling, redness of forearms, Raynaud's phenomenon, joint pain, myalgia and muscle weakness. Eosinophilia was not found and serum creatine kinase activity was normal, while aldolase was markedly elevated. Abnormal signals suggesting synovitis and myofasciitis were found on MRI images. Biopsy of the fascia of quadriceps femoris showed perivascular mononuclear cell infiltration. A muscle biopsy showed mononuclear cell infiltration mainly in the perimysium extending to the endmysium. Eosinophilic cells were not found, Perifascicular atrophy was observed. Corticosteroid therapy improved clinical symptoms and serum aldolase level. We diagnosed him as non-eosinophilic myofasciitis and synovitis with perifascicular atrophy. The serum aldolase activity is usuful for diagnosis and for monitoring the disease activity.
一名35岁男性在行走5个月时出现肌痛和关节疼痛。体格检查和神经学检查发现皮肤硬化、皮肤肿胀、前臂发红、雷诺现象、关节疼痛、肌痛和肌肉无力。未发现嗜酸性粒细胞增多，血清肌酸激酶活性正常，而醛缩酶明显升高。MRI图像显示提示滑膜炎和肌筋膜炎的异常信号。股四头肌筋膜活检显示血管周围单核细胞浸润。肌肉活检显示单核细胞浸润主要在肌束膜，延伸至肌内膜。未发现嗜酸性细胞，观察到束周萎缩。皮质类固醇治疗改善了临床症状和血清醛缩酶水平。我们将其诊断为非嗜酸性肌筋膜炎和滑膜炎伴束周萎缩。血清醛缩酶活性对诊断和监测疾病活动有用。
