Fairris Catherine, Darvay Amrit
Department of Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
BMJ Case Rep. 2014 Jun 25;2014:bcr2013202210. doi: 10.1136/bcr-2013-202210.
A 63-year-old man was referred to the rheumatology unit with myalgia, arthralgia and a widespread rash. He was investigated for rheumatological disease; however, this did not yield any specific findings. His symptoms were attributed to statin use and newly started antihypertensives which were promptly discontinued. There was some subsequent improvement in his symptoms so he was discharged. He re-presented 3 years later with pelvic bone pain which had responded to a course of oral steroids started by the general practitioner, who was treating a presumed diagnosis of polymyalgia rheumatica. However, MRI of the pelvis showed bone marrow oedema and the diagnosis was changed to mastocytosis. He did not tolerate or respond to initial treatment. It was not until a second opinion was sought from the dermatologists that the diagnosis of Schnitzler's syndrome was made and treatment with anakinra (an interleukin-1 receptor antagonist) was started with almost complete resolution of his symptoms.
一名63岁男性因肌痛、关节痛和广泛皮疹被转诊至风湿病科。他接受了风湿病相关检查；然而，未发现任何特异性结果。他的症状被归因于他汀类药物的使用以及新开始使用的抗高血压药物，这些药物随即停用。随后他的症状有所改善，因此出院。3年后，他因骨盆骨疼痛再次就诊，全科医生开始给予口服类固醇治疗，初步诊断为风湿性多肌痛，疼痛得到缓解。然而，骨盆的磁共振成像显示骨髓水肿，诊断改为肥大细胞增多症。他对初始治疗不耐受且无反应。直到向皮肤科医生寻求第二种意见后，才确诊为施尼茨勒综合征，并开始使用阿那白滞素（一种白细胞介素-1受体拮抗剂）治疗，他的症状几乎完全缓解。
