Hoffman G S, Myers R L, Stark F R, Thoen C O
J Rheumatol. 1978 Summer;5(2):199-209.
A 58 year old man, with systemic lupus erythematosus, developed septic arthritis due to an atypical mycobacterium, M. avium. The patient's course, as well as 46 cases reviewed from the literature, illustrates the insidious nature of atypical mycobacterial infections. Septic arthritis or peri-arthritis was generally not suspected at initial evaluation, leading or at least 40% of patients receiving intra-articular steroids for non-specific reasons. A diagnosis was eventually obtained in 85% of cases by surgical biopsy and culture. In only15% was a diagnosis made by culture of synovial or bursal fluid. The relative in vitro resistance of "atypicals" to antituberculous drugs and the frequent necessity for surgery to make a diagnosis, led to surgery consituting partial or total therapy in 89% of cases. Whether patients were treated with surgery alone, surgery plus antituberculous drugs, or antituberculous drugs alone, clinical improvement generally occured. Because most patients had limited follow-up and because atypical mycobacterial infections often relapse, none of the cases reviewed should be considered "cures", be but rather instances of clinically inactive disease.
一名58岁的男性系统性红斑狼疮患者因非典型分枝杆菌鸟分枝杆菌感染而患上感染性关节炎。该患者的病程以及从文献中回顾的46例病例，均显示出非典型分枝杆菌感染的隐匿性。在初始评估时，通常不会怀疑感染性关节炎或关节周围炎，导致至少40%的患者因非特异性原因接受关节内注射类固醇治疗。最终，85%的病例通过手术活检和培养得以确诊。仅有15%的病例通过滑膜或滑囊液培养确诊。“非典型”分枝杆菌对抗结核药物的相对体外耐药性以及为明确诊断而频繁进行手术的必要性，导致在89%的病例中，手术成为部分或全部治疗手段。无论患者是仅接受手术治疗、手术加抗结核药物治疗还是仅接受抗结核药物治疗，临床症状通常都会改善。由于大多数患者的随访时间有限，且非典型分枝杆菌感染常复发，因此所回顾的病例中没有一例应被视为“治愈”，而应视为临床症状不活跃的病例。
