慢性関節リウマチとして約11カ月間ステロイド治療が行われた骨関節結核の1例 A CASE OF MULTIPLE BONE AND JOINT TUBERCULOSIS WHICH HAD BEEN MISDIAGNOSED AS THE RHEUMATOID ARTHRITIS AND TREATED WITH PREDNISOLONE FOR ELEVEN MONTHS
症例は34歳, 男性。多発関節痛に対し, 慢性関節リウマチとしてステロイド治療が行われていた。レントゲン上骨の萎縮, 関節軟骨の破壊を認めており, 関節周囲結節状隆起の穿刺液から骨関節結核と診断がついた。抗結核剤4剤 (Isoniazid, Rifampicin, Ethambutol, Pyrazinamide) にて治療したが, 局所の感染コントロールがつかず, 腐骨の切除目的に右手根骨, 右足根骨の掻爬, 洗浄, 滑膜切除術を施行した。術後疼痛は消失し, 関節可動域に制限を残すが, 歩行可能となった。難治性の骨関節痛が持続する場合, 骨関節結核も念頭におくべきである。
A 34-year-old man had a multiple arthralgia for about eleven months. The swelling of his right wrist and foot had appeared in the dorsal side, and he had been misdiagnosed as the rheumatoid arthritis. He was treated with prednisolone in the dosages of 2.5 mg per day for one month, and 10 mg per day for ten months.<BR>When he admitted to our hospital, the bone X-ray examinations of the wrist and foot revealed the marked atrophy and destruction of the carpal and tarsal bones. The aspiration fluid from the swelling around his wrist and foot was positive for acid-fast bacilli on smear and <I>Mycobacterium tuberculosis</I> was found on culture. He was treated with isoniazid, rifampicin, ethambutol and pyrazinamide, however, these medication was not adequately effective to his complications of tuberculous arthritis.<BR>Curettage, irrigation and synovectomy of his right carpal and tarsal bone were performed in order to control his bone and joint infection. He recovered from his arthritis and tenosynovitis after these operations. The clinical practitioners should not omit tuberculosis from the differential diagnosis of persistent osteoarthralgia.
結核 77(4), 361-366, 2002-04-15
JAPANESE SOCIETY FOR TUBERCULOSIS