Estimable Kerlie, Rizk Cynthia, Pujalte George G A
From the Departments of Family and Community Medicine (KE, CR, GGAP) and Orthopaedics and Rehabilitation (GGAP), Penn State Milton S. Hershey Medical Center, Hershey, PA.
J Am Board Fam Med. 2015 Jan-Feb;28(1):146-50. doi: 10.3122/jabfm.2015.01.140124.
We present a rare case of severe neck pain in a 45-year-old man with severe hidradenitis suppurativa who was participating in a study involving adalimumab. The neck pain was associated with acute longus colli calcific tendinitis, which is a noninfectious inflammatory response in the longus colli tendons secondary to deposition of calcium hydroxyapatite crystal. The diagnosis was made by computed tomography, which showed calcifications and deposits, and magnetic resonance imaging, which showed a retropharyngeal effusion. Ears, Nose, and Throat Services performed a fiberoptic scope examination, which revealed a patent airway and no drainable abscess. Nonsteroidal anti-inflammatory drugs resulted in a dramatic improvement in the patient's clinical symptoms. In acute longus colli tendinitis, differentiating retropharyngeal aseptic effusion from infection is important. Of note, the confounding factor in this case was that the patient was blinded to whether he was receiving the placebo or adalimumab, so whether the patient was immunosuppressed and at risk for infection was unknown. Clinician familiarity and education concerning acute calcific longus colli tendinitis may lead to decreased costs stemming from incorrect diagnosis and unnecessary treatment.
我们报告了一例罕见病例，一名45岁患有重度化脓性汗腺炎的男性在参与一项涉及阿达木单抗的研究时出现严重颈部疼痛。颈部疼痛与急性颈长肌钙化性肌腱炎有关，这是一种由于羟基磷灰石晶体沉积继发于颈长肌肌腱的非感染性炎症反应。通过计算机断层扫描诊断，其显示有钙化和沉积物，以及磁共振成像，其显示有咽后积液。耳鼻喉科进行了纤维内镜检查，结果显示气道通畅且无可引流的脓肿。非甾体类抗炎药使患者的临床症状有显著改善。在急性颈长肌肌腱炎中，区分咽后无菌性积液与感染很重要。值得注意的是，该病例中的一个混杂因素是患者对自己接受的是安慰剂还是阿达木单抗并不知情，因此患者是否免疫抑制以及是否有感染风险并不清楚。临床医生对急性钙化性颈长肌肌腱炎的熟悉程度和相关教育可能会降低因错误诊断和不必要治疗而产生的费用。
