Krabbe Simon, Engelhart Merete, Thybo Sören, Jacobsen Søren
Center for Rheumatology and Spine Diseases, Rigshospitalet, 2600 Glostrup, Denmark.
Center for Rheumatology and Spine Diseases, Gentofte Hospital, 2900 Hellerup, Denmark.
Case Rep Rheumatol. 2017;2017:4029271. doi: 10.1155/2017/4029271. Epub 2017 Sep 27.
This case report describes a patient with scleroderma who developed infection, which for more than a year mimicked worsening of her connective tissue disorder. The patient was diagnosed with scleroderma based on puffy fingers that developed into sclerodactyly, abnormal nail fold capillaries, interstitial lung disease, Raynaud's phenomenon, esophageal dysmotility, and positivity for rheumatoid factor and anti-SSA antibodies. She developed massive inflammatory changes of the cutis, the subcutis, and the muscle fasciae of the right leg, that after several failed attempts of immunosuppressive treatments were found to be caused by . While she was receiving high-dose prednisolone, as worsening of her connective tissue disease was suspected to be the cause of the inflammatory changes, she had meningitis and was hospitalized for several weeks, but she recovered from this without sequelae. After infection was diagnosed, she was treated with clarithromycin and rifampicin. Her skin manifestations, arthralgias, and fatigue improved considerably, and the wounds of the right leg healed, unfortunately with significant scarring. Immunodeficiency testing was unremarkable. In summary, an infection with was mistaken for an unusually severe progression of scleroderma.
本病例报告描述了一名硬皮病患者发生感染，这种感染持续一年多，被误诊为其结缔组织病的病情恶化。该患者基于以下症状被诊断为硬皮病：手指肿胀发展为指端硬化、甲襞毛细血管异常、间质性肺病、雷诺现象、食管运动障碍以及类风湿因子和抗SSA抗体呈阳性。她的右下肢皮肤、皮下组织和肌筋膜出现大量炎症改变，在多次免疫抑制治疗失败后，发现这些炎症改变是由……引起的。在她接受大剂量泼尼松龙治疗时，由于怀疑结缔组织病病情恶化是炎症改变的原因，她发生了脑膜炎并住院数周，但康复后未留下后遗症。在确诊感染……后，她接受了克拉霉素和利福平治疗。她的皮肤表现、关节痛和疲劳症状有了显著改善，右腿伤口愈合，但不幸留下了明显的疤痕。免疫缺陷检测结果无异常。总之，……感染被误诊为硬皮病异常严重的进展。
