Internal Medicine Department, G. Papanikolaou General Hospital, Thessaloniki, Greece.
J Med Case Rep. 2020 Sep 17;14(1):155. doi: 10.1186/s13256-020-02479-6.
We report a case of a 30-year-old patient who presented with acute Mycoplasma pneumoniae infection that was complicated by reactive arthritis and asymmetric proximal myopathy and progressed to chronic spondyloarthropathy. Reactive arthritis and sacroiliitis are unusual extrapulmonary manifestations of M. pneumoniae infection, which is a common condition.
A 30-year-old Greek previously healthy man presented to our emergency department with fever, progressively worsening bilateral lower limb weakness, and asymmetric oligoarthritis. Our diagnosis was based on a positive polymerase chain reaction test for M. pneumoniae using blood and cerebrospinal fluid and magnetic resonance imaging findings that suggested sacroiliitis. Our patient was also found to be human leukocyte antigen B27 positive. His infection was successfully treated with a 14-day course of doxycycline; the arthritis was treated with naproxen and corticosteroids. His arthritis, which restricted his mobility, improved progressively, and he was discharged without any neurological symptoms.
In our case, an acute M. pneumoniae infection eventually progressed to chronic spondyloarthropathy. In our patient, M. pneumoniae infection may represent a random event, or it might be a necessary factor for the development of reactive arthritis, asymmetric proximal myopathy, and sacroiliitis, always in combination with the appropriate genetic background. Extrapulmonary manifestations of M. pneumoniae may occur even in the complete absence of respiratory symptoms, and the diagnosis of unusual complications, such as reactive arthritis, requires high clinical suspicion and extensive investigation.
我们报告了一例 30 岁患者，其急性肺炎支原体感染并发反应性关节炎和不对称性近端肌病，并进展为慢性脊柱关节病。反应性关节炎和骶髂关节炎是肺炎支原体感染的不常见肺外表现，肺炎支原体感染较为常见。
一位 30 岁的希腊籍既往健康男性因发热、逐渐加重的双侧下肢无力和不对称少关节炎就诊于我院急诊科。我们的诊断基于血和脑脊液中肺炎支原体聚合酶链反应检测阳性和磁共振成像提示的骶髂关节炎。我们还发现该患者人类白细胞抗原 B27 阳性。他的感染经 14 天多西环素治疗成功治愈；关节炎采用萘普生和皮质类固醇治疗。他的关节炎限制了他的活动能力，逐渐改善，出院时无任何神经症状。
在我们的病例中，急性肺炎支原体感染最终进展为慢性脊柱关节病。在我们的患者中，肺炎支原体感染可能是随机事件，也可能是反应性关节炎、不对称性近端肌病和骶髂关节炎发展的必要因素，始终与适当的遗传背景相结合。肺炎支原体的肺外表现即使在没有呼吸道症状的情况下也可能发生，反应性关节炎等不常见并发症的诊断需要高度的临床怀疑和广泛的调查。
