全身性紅斑性狼瘡合併結核性關節炎－－病例報告

Systemic Lupus Erythematosus with Tuberculous Arthritis-- A Case Report

一位三十七歲男性全身性紅斑狼瘡病人罹患左側肘關節炎及左側腕關節炎。由其關節液的培養可分離出結核桿菌。其關節滑囊切片可清楚看到肉芽腫的存在。因此被確定診斷為結核性關節炎。後來經外科手術及抗結核藥物合併治療後成效良好。雖然結核性關節炎是結核病中較不尋常的表現，它仍然時有發生且可能引起相當嚴重的後遺症。但是此疾病經常到關節已發生永久損害才被診斷出來，最重要的原因在鑑別診斷狼瘡病人關節炎時未將此病考慮進去。

A 37-year-old male was presented, who is a systemic lupus erythematosus (SLE) patient, with an unusual presentation of tuberculous joint disease involving 2 peripheral joints, left elbow and left wrist. Mycobacterium tuberculosis was isolated from the synovial fluid of left elbow joint. Synovial biopsy taken from the joint showed typical tuberculous granuloma. Combined anti-tuberculosis chemotherapy and surgical intervention were effective. Although skeletal tuberculosis is an uncommon manifestation of tuberculosis, it still occurs and may cause devastating sequelae. It is freguently not diagnosed prior to the onset of permanent damage to the joints or spines; the most important reason for this delay may be the unconsideration in differential diagnosis, especially in patients with SLE.