Jayamali W D, Herath H M M T B, Kulatunga Aruna
National Hospital of Sri Lanka, Colombo, Sri Lanka.
J Med Case Rep. 2017 Nov 1;11(1):307. doi: 10.1186/s13256-017-1483-0.
Dengue is a common arthropod-borne viral infection in Sri Lanka which is spread by the mosquitos of the genus Aedes. The clinical features of dengue include high-grade fever associated with arthralgia and myalgia. However, dengue virus is not considered an arthritogenic virus. We report a case of a previously healthy young female who presented with imaging-confirmed right-sided sacroiliitis 10 days after developing dengue fever. This is the first reported case that shows a possible link between dengue infection and development of arthritis.
A 14-year-old Sri Lankan female presented to our medical unit with right buttock and hip pain of 3 weeks' duration. She had serologically confirmed dengue infection 10 days prior to the onset of buttock pain. A clinical examination revealed features of right sacroiliitis. An X-ray of her sacroiliac joint showed joint space widening and reactive bone changes. Magnetic resonance imaging of her pelvis and sacroiliac joint confirmed the diagnosis of acute sacroiliitis. She had an erythrocyte sedimentation rate of 110 mm first hour with a normal C-reactive protein. Her human leukocyte antigen-B27, rheumatoid factor, antinuclear antibody, chikungunya antibody, hepatitis serology, Brucella serology, and tuberculin skin test were negative. She was treated with nonsteroidal anti-inflammatory drugs and showed gradual improvement.
After excluding possible causes for sacroiliitis, we postulated that sacroiliitis in the index case could have been caused or triggered by dengue virus infection. However there is a possibility that the sacroiliitis merely coincided with the dengue virus infection. This case illustrates the possibility that dengue virus could have a link with the development of arthritis in the same manner as other arthritogenic viruses; possible mechanisms for this include direct invasion of the synovium and the joint tissue by the virus, immune complex formation and deposition in the joint tissue, and immune dysregulation. Further studies are needed in this field to gain more knowledge, as dengue infection is highly prevalent in Sri Lanka.
登革热是斯里兰卡一种常见的虫媒病毒感染，由伊蚊属蚊子传播。登革热的临床特征包括高热伴关节痛和肌痛。然而，登革热病毒不被认为是一种致关节炎病毒。我们报告一例既往健康的年轻女性病例，该患者在患登革热10天后出现影像学确诊的右侧骶髂关节炎。这是首例显示登革热感染与关节炎发病之间可能存在关联的报告病例。
一名14岁的斯里兰卡女性因右臀部和髋部疼痛3周前来我院就诊。在臀部疼痛发作前10天，她经血清学确诊感染登革热。临床检查发现右侧骶髂关节炎的体征。她的骶髂关节X线显示关节间隙增宽和反应性骨质改变。骨盆和骶髂关节的磁共振成像确诊为急性骶髂关节炎。她的红细胞沉降率在第1小时为110mm，C反应蛋白正常。她的人类白细胞抗原-B27、类风湿因子、抗核抗体、基孔肯雅病毒抗体、肝炎血清学、布鲁氏菌血清学及结核菌素皮肤试验均为阴性。她接受了非甾体抗炎药治疗并逐渐好转。
在排除骶髂关节炎的可能病因后，我们推测该病例中的骶髂关节炎可能由登革热病毒感染引起或触发。然而，骶髂关节炎也有可能只是与登革热病毒感染同时发生。该病例说明了登革热病毒可能与其他致关节炎病毒一样与关节炎发病存在关联；其可能机制包括病毒直接侵袭滑膜和关节组织、免疫复合物在关节组织中形成和沉积以及免疫失调。由于登革热感染在斯里兰卡非常普遍，该领域需要进一步研究以获取更多知识。
