Mamane W, Falcone M-O, Doursounian L, Nourissat G
Service d'orthopédie-traumatologie, SOS mains, hôpital St-Antoine, Paris, France.
Chir Main. 2010 Oct;29(5):335-7. doi: 10.1016/j.main.2010.06.011. Epub 2010 Jul 24.
Isolated gonococcal tenosynovitis is rare, and is part of disseminated gonococcal infection. It is due to blood-borne contamination of the flexor tendon sheath. One to 3% of gonococcal mucosal infections develop disseminated infections. Tenosynovitis is present in two-thirds of cases, sometimes in association with arthritis and skin rash. We report a case of a 26-year-old man with isolated gonococcal tenosynovitis of the thumb, with no other medical history, occurring 15 days after unprotected sex. Except local inflammatory signs of the thumb extending to the wrist, and a biological inflammatory syndrome, the patient had no arthritis, skin or mucosa symptoms. Immediate surgical drainage was performed under antibiotic cover with 3rd generation cephalosporin. All bacteriological samples were negative, except for one blood culture positive for Neisseria gonorrhoeae. Thus, in case of an asymptomatic patient with suspected gonococcal infection through a mucus portal, a precise examination, including geographical and sexual history, and a review of screening are recommended. Although the pathophysiology of gonococcal tenosynovitis is still obscure, the best prevention remains that of sexually transmitted diseases.
孤立性淋菌性腱鞘炎较为罕见，是播散性淋菌感染的一部分。它是由血源性污染屈肌腱鞘所致。1%至3%的淋菌性黏膜感染会发展为播散性感染。三分之二的病例会出现腱鞘炎，有时还伴有关节炎和皮疹。我们报告一例26岁男性，患拇指孤立性淋菌性腱鞘炎，无其他病史，发生于无保护性行为15天后。除拇指局部炎症体征延伸至腕部以及存在生物学炎症综合征外，患者无关节炎、皮肤或黏膜症状。在使用第三代头孢菌素进行抗生素覆盖的情况下立即进行了手术引流。除一份血培养淋病奈瑟菌阳性外，所有细菌学样本均为阴性。因此，对于疑似通过黏膜途径感染淋菌的无症状患者，建议进行精确检查，包括地域和性病史以及筛查回顾。尽管淋菌性腱鞘炎的病理生理学仍不明确，但最佳预防措施仍是预防性传播疾病。
