Luke W A N V, Gunathilake M P M L, Munidasa Duminda, Munidasa Dilshan, De Silva S T
Department of Clinical Pharmacology, Faculty of Medicine, University of Kelaniya, Dalugama, Sri Lanka.
Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
BMC Res Notes. 2017 Jul 28;10(1):343. doi: 10.1186/s13104-017-2629-2.
Unusual forms of tuberculosis are common among immune-suppressed patients, leading to challenges in diagnosis and management. We present a Sri Lankan patient with systemic lupus erythematosis, investigated for chronic wrist pain with low inflammatory markers and without systemic symptoms, who was subsequently diagnosed to have tuberculosis of the joint.
A 31-year-old woman with systemic lupus erythematosis in remission was evaluated for chronic left wrist pain without significant examination findings on presentation. She did not have any constitutional symptoms. Basic investigations did not reveal any significant abnormalities. She was treated with increasing immunosuppression as for lupus related arthritis. Subsequently she developed a wrist effusion with high inflammatory markers, and was treated as septic arthritis. Synovial biopsy features suggested tuberculosis. The patient's symptoms improved with surgical intervention and anti-tuberculosis treatment.
Tuberculosis should be considered in patients with systemic arthritis with unusual symptoms. Delayed diagnosis along with continuing immunosuppression can lead to extensive tissue damage. Clinically detectable effusions should be analyzed along with synovial biopsy in order to exclude concurrent infections. Radiography of the joint has poor sensitivity to detect early joint damage, but changes may be evident early on magnetic resonance imaging, sothis should be considered in patients with unusual features.
不典型的结核病在免疫抑制患者中很常见，这给诊断和治疗带来了挑战。我们报告一名患有系统性红斑狼疮的斯里兰卡患者，该患者因慢性腕关节疼痛接受检查，炎症指标较低且无全身症状，随后被诊断为关节结核。
一名31岁处于缓解期的系统性红斑狼疮女性因慢性左腕关节疼痛接受评估，初诊时检查未发现明显异常。她没有任何全身症状。基本检查未发现任何重大异常。她接受了针对狼疮相关关节炎的递增免疫抑制治疗。随后她出现了伴有高炎症指标的腕关节积液，并被当作化脓性关节炎治疗。滑膜活检特征提示为结核。患者的症状通过手术干预和抗结核治疗得到改善。
对于有不寻常症状的系统性关节炎患者应考虑结核病。诊断延迟以及持续的免疫抑制会导致广泛的组织损伤。临床上可检测到的积液应与滑膜活检一起进行分析，以排除并发感染。关节X线摄影对早期关节损伤的检测敏感性较差，但磁共振成像早期可能会出现明显变化，因此对于有不寻常特征的患者应考虑进行磁共振成像检查。
