Eichenfield A H, Goldsmith D P, Benach J L, Ross A H, Loeb F X, Doughty R A, Athreya B H
J Pediatr. 1986 Nov;109(5):753-8. doi: 10.1016/s0022-3476(86)80688-6.
We report 25 children with oligoarticular arthritis associated with Lyme disease. There were 16 boys (male/female ratio 1.8:1); ages ranged from 2 to 15 years. Thirteen (52%) children had no history of erythema chronicum migrans or other rash. Thirteen had temperatures as high as 41 degrees C for up to 2 months before the onset of arthritis. Twelve recalled definite tick bites. Ten (40%) children, of whom seven had no history of rash, were hospitalized for presumed septic arthritis. Another four had diagnoses of pauciarticular juvenile rheumatoid arthritis for as long as 3 years. Seven patients had less acute, recurrent episodes of synovitis. Two children had seventh nerve palsies 2 months before onset of arthritis. All patients had antibodies to the Lyme spirochete. In 14 patients, synovial fluid white blood cell counts ranged from 180 to 97,700/mm3 (greater than or equal to 76% polymorphonuclear leukocytes). Antibiotic therapy was effective in all patients; in 13, orally administered therapy alone resulted in elimination of synovitis and recurrent attacks. Lyme arthritis may be confused with acute bacterial septic arthritis or recurrent "pauciarticular juvenile rheumatoid arthritis," particularly when there is no history of erythema chronicum migrans.
我们报告了25例与莱姆病相关的少关节型关节炎患儿。其中有16名男孩（男女比例为1.8:1）；年龄在2至15岁之间。13名（52%）儿童无慢性游走性红斑或其他皮疹病史。13名儿童在关节炎发作前长达2个月体温高达41摄氏度。12名儿童回忆起有明确的蜱虫叮咬史。10名（40%）儿童因疑似化脓性关节炎住院，其中7名无皮疹病史。另外4名儿童被诊断为少关节型幼年类风湿关节炎长达3年。7名患者有不太急性的复发性滑膜炎发作。2名儿童在关节炎发作前2个月出现面神经麻痹。所有患者均有抗莱姆螺旋体抗体。14名患者的滑液白细胞计数在180至97,700/mm³之间（多形核白细胞大于或等于76%）。抗生素治疗对所有患者均有效；13名患者仅口服治疗就消除了滑膜炎和复发发作。莱姆关节炎可能会与急性细菌性化脓性关节炎或复发性“少关节型幼年类风湿关节炎”相混淆，尤其是在没有慢性游走性红斑病史的情况下。
