Gertner E, Inman R D
Arthritis Rheum. 1986 Jul;29(7):910-2. doi: 10.1002/art.1780290715.
Synovitis in toxic shock syndrome (TSS) is an unusual finding. A 31-year-old man presented with pain and swelling in both knees and was found to have TSS, secondary to a septic bursitis caused by Staphylococcus aureus. Immune complexes were not detected in serum or synovial fluid, and the S aureus was not recovered from the inflamed joints. Antibodies against the TSS toxin-1 were detected in serum and synovial fluid, but in lower levels than would be seen in a normal control serum. Complement studies implicated alternative pathway activation by a marked diminution in C3 levels compared with C4 levels, and by lower levels of factor B than would be found in other inflammatory joint diseases. The diagnostic dilemma posed by TSS in a man is discussed.
中毒性休克综合征（TSS）中的滑膜炎是一种不常见的表现。一名31岁男性因双膝疼痛和肿胀就诊，被诊断为TSS，继发于金黄色葡萄球菌引起的化脓性滑囊炎。血清和滑液中未检测到免疫复合物，发炎关节中也未培养出金黄色葡萄球菌。血清和滑液中检测到抗TSS毒素-1抗体，但水平低于正常对照血清。补体研究表明，与C4水平相比，C3水平显著降低，且B因子水平低于其他炎症性关节疾病，提示替代途径激活。本文讨论了男性TSS所带来的诊断难题。
