Sato Hiroe, Iino Noriaki, Ohashi Riuko, Saeki Takako, Ito Tomoyuki, Saito Maki, Tsubata Yutaka, Yamamoto Suguru, Murakami Shuichi, Kuroda Takeshi, Tanabe Yoshinari, Fujisawa Junichi, Murai Takehiro, Nakano Masaaki, Narita Ichiei, Gejyo Fumitake
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Intern Med. 2012;51(4):425-9. doi: 10.2169/internalmedicine.51.6058. Epub 2012 Feb 15.
Hypogammaglobulinemia is a reduction or absence of immunoglobulin, which may be congenital or associated with immunosuppressive therapy. In addition to infectious diseases, autoimmune diseases have also been reported in patients with hypogammaglobulinemia. A 26-year-old man with hypogammaglobulinemia had multiple joint pain and swelling with erosive changes in the proximal interphalangeal joint of the right middle finger on X-ray film, mimicking rheumatoid arthritis (RA). As polyarthritis remained after immunoglobulin replacement therapy and there was no finding indicating any infection at that time, a diagnosis of RA was made. Prednisolone and etanercept were started. However, his polyarthritis did not improve and he developed meningitis and massive brain ischemia. Finally, a diagnosis of disseminated Mycoplasma hominis infection was made. The differential diagnosis of polyarthritis in patients with hypogammaglobulinemia should strictly exclude Mycoplasma infection by culture with special media or longer anaerobic culture, and molecular methods for mycoplasma.
低丙种球蛋白血症是指免疫球蛋白减少或缺乏，可为先天性或与免疫抑制治疗有关。除了传染病外，低丙种球蛋白血症患者还曾有自身免疫性疾病的报道。一名26岁的低丙种球蛋白血症男性出现多处关节疼痛和肿胀，X线片显示右手中指近端指间关节有侵蚀性改变，类似类风湿关节炎（RA）。在进行免疫球蛋白替代治疗后多关节炎仍持续存在，且当时未发现任何感染迹象，于是诊断为RA。开始使用泼尼松龙和依那西普治疗。然而，他的多关节炎并未改善，随后出现了脑膜炎和大面积脑缺血。最终，诊断为播散性人型支原体感染。对于低丙种球蛋白血症患者的多关节炎进行鉴别诊断时，应通过使用特殊培养基培养或延长厌氧培养以及支原体分子检测方法，严格排除支原体感染。
