Arai H, Itoh A, Ohta Y
Department of Dermatology, Yamato City Hospital.
Nihon Hifuka Gakkai Zasshi. 1990 May;100(6):721-7.
The patient is 48 year-old female who has been followed as MCTD with nonsteroidal therapies for 18 years. Sometimes she has been attached by focal severe muscle pain. One year ago, she had general myalgia associated with high fever and arthralgia. The results of the examination, aldolase, GOT, GPT, gamma-GTP, CRP and leucocyte were increased. Muscle biopsy showed noncaseating epithelioid granuloma being in contact with enlarged injected vessels. Out of tough with granuloma, a few fibre necroses, fibrosis of muscle, and degeneration of collagen fiber were recognized. After treatment of nonsteroidal antiinflammatory agents, her every complain was removed. Her muscle looks normal herself. MCTD has myopathy caused by inflammatory infiltrates and fibre necroses. But granulomatous myositis is very rare. It is difficult to differentiate our case from sarcoidosis, especially acute isolated muscle sarcoidosis.
该患者为48岁女性，因混合性结缔组织病（MCTD）接受非甾体类药物治疗已18年。她有时会出现局部严重肌肉疼痛。一年前，她出现全身肌痛，伴有高热和关节痛。检查结果显示，醛缩酶、谷草转氨酶、谷丙转氨酶、γ-谷氨酰转肽酶、C反应蛋白和白细胞升高。肌肉活检显示非干酪样上皮样肉芽肿与扩张的充血血管相连。在肉芽肿周围，可见少量纤维坏死、肌肉纤维化和胶原纤维变性。经非甾体类抗炎药治疗后，她的所有症状均消失。她的肌肉外观正常。MCTD可导致由炎症浸润和纤维坏死引起的肌病。但肉芽肿性肌炎非常罕见。很难将我们的病例与结节病区分开来，尤其是急性孤立性肌肉结节病。
