Journal of Tuberculosis and Lung Disease ›› 2022, Vol. 3 ›› Issue (5): 364-370.doi: 10.19983/j.issn.2096-8493.20220099
• Original Articles • Previous Articles Next Articles
Li Yan, Han Tongxin, Piao Yurong, Mao Huawei()
Received:
2022-06-12
Online:
2022-10-20
Published:
2022-10-14
Contact:
Mao Huawei
E-mail:maohwei@qq.com
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CLC Number:
Li Yan, Han Tongxin, Piao Yurong, Mao Huawei. Clinical analysis of five children with joint tuberculosis misdiagnosed juvenile idiopathic arthritis[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(5): 364-370. doi: 10.19983/j.issn.2096-8493.20220099
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URL: http://www.jtbld.cn/EN/10.19983/j.issn.2096-8493.20220099
资料内容 | 病例1 | 病例2 | 病例3 | 病例4 | 病例5 |
---|---|---|---|---|---|
性别 | 男 | 男 | 女 | 女 | 男 |
起病年龄 | 14岁11个月 | 8个月 | 11岁3个月 | 12岁11个月 | 2岁4个月 |
延误诊断时间(月) | 1 | 16 | 2 | 12 | 1 |
结核病密切接触史 | 有 | 无 | 无 | 无 | 有 |
卡介苗接种史/卡疤 | 有/阳性 | 有/阳性 | 有/阳性 | 有/阳性 | 有/阳性 |
既往结核病病史 | 无 | 无 | 无 | 无 | 无 |
家族史 | 无 | 无 | 无 | 无 | 无 |
首发表现 | 关节疼痛 | 关节疼痛 | 发热 | 关节疼痛 | 发热 |
患病期间发热 | 有 | 无 | 有 | 无 | 有 |
受累关节 | 右膝关节、双侧骶髂关节、双髋关节 | 左膝关节 | 左侧骶髂关节、左髋关节 | 左膝关节、左踝关节 | 双膝关节、双踝关节 |
关节症状及查体 | 疼痛,僵直,双侧4字征阳性 | 疼痛,肿胀,活动受限,皮温升高 | 疼痛,活动受限,晨僵,左侧4字征阳性 | 疼痛,肿胀,活动受限,皮温升高 | 疼痛,肿胀,活动受限,皮温升高,局部发红 |
其他表现 | 咳嗽、胸闷、气短、乏力,体质量明显下降 | 消瘦 | 乏力 | 盗汗 | 盗汗,多发淋巴结肿大 |
白细胞计数(×109/L) | 6.6 | 8.6 | 7.8 | 6.5 | 9.2 |
中性粒细胞百分比(%) | 70.2 | 40.0 | 67.6 | 58.4 | 57.9 |
淋巴细胞百分比(%) | 21.7 | 45.9 | 24.6 | 33.7 | 27.8 |
C反应蛋白(mg/L) | 46.1 | 25.4 | 26.0 | <3.6 | 24.0 |
血红细胞沉降率(mm/1h) | 29.0 | 36.0 | 75.0 | 15.0 | 53.0 |
PPD试验 | +++ | ++ | 阴性 | ++ | ++ |
T-SPOT.TB | 阳性 | 阳性 | 阴性→阳性 | 阳性 | 阳性 |
其他病原学检查 | 未做 | 左膝关节滑膜抗酸染色(+) | 未做 | 左膝关节积液抗酸染色(+) | 未做 |
肺部高分辨CT | 结核性胸膜炎 | 原发性肺结核(钙化期) | 未见异常 | 未见异常 | 血行播散性肺结核 |
关节影像 | CT:骶髂和髋关节炎 | CT:左膝关节炎 | MRI:骶髂关节炎 | CT:左膝关节炎 | X线:关节炎 |
误诊疾病 | ERA | OJIA | ERA | OJIA | OJIA |
治疗方案及转归 | H-R-E-Z方案→好转 | 抗风湿治疗→加重→停用原药物,予H-R-E-Z方案→好转,遗留后遗症 | 抗风湿治疗→加重→停用原药物;H-R方案→好转 | 抗风湿治疗→加重→停用原药物,予H-R-E-Z方案→好转,遗留后遗症 | H-R-E-Z方案→好转,遗留后遗症 |
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