Kostman J R, Rush P, Reginato A J
Department of Medicine, Cooper Hospital/University Medical Center, Robert Wood Johnson Medical School, Camden, New Jersey, USA.
Clin Infect Dis. 1995 Jul;21(1):217-9. doi: 10.1093/clinids/21.1.217.
Granulomatous inflammation in a tissue specimen raises concern about infection with Mycobacterium tuberculosis, atypical mycobacteria, certain fungi, Brucella species, and other infectious agents. Inflammatory disorders, such as sarcoidosis, crystal-associated arthritis, or foreign body reactions also are considered when granulomatous changes are seen on histological examination of a tissue specimen. We describe two cases of granulomatous tenosynovitis due to tophaceous deposits in patients with gout. In one case, tuberculous synovitis was considered the primary diagnosis until the diagnosis of gout was confirmed by examination of a tissue specimen with polarized light. In the second case, gout and tuberculosis were found in the patient's wrist joint. After antituberculous therapy was discontinued, he continued to have wrist synovitis and chronic drainage due to granulomatous tophaceous gout. The findings in this report suggest that gouty tenosynovitis can mimic tuberculous tenosynovitis and that gout should be considered in the differential diagnosis of granulomatous tenosynovitis, especially when acid-fast stains and cultures are negative for mycobacteria.
组织标本中的肉芽肿性炎症引发了对结核分枝杆菌、非结核分枝杆菌、某些真菌、布鲁氏菌属及其他感染因子感染的担忧。当在组织标本的组织学检查中发现肉芽肿性改变时，也会考虑炎症性疾病，如结节病、晶体相关性关节炎或异物反应。我们描述了两例痛风患者因痛风石沉积导致的肉芽肿性腱鞘炎病例。在一例病例中，直到通过偏振光检查组织标本确诊痛风之前，结核性滑膜炎一直被视为主要诊断。在第二例病例中，患者的腕关节同时发现了痛风和结核。停用抗结核治疗后，由于肉芽肿性痛风石性痛风，他的腕部滑膜炎和慢性引流仍持续存在。本报告中的发现表明，痛风性腱鞘炎可模仿结核性腱鞘炎，在肉芽肿性腱鞘炎的鉴别诊断中应考虑痛风，尤其是当抗酸染色和培养结果显示分枝杆菌为阴性时。
