在地方性环境中模拟结核性关节炎的丛林斑疹伤寒相关炎性少关节炎
Scrub Typhus-Associated Inflammatory Oligoarthritis Mimicking Tubercular Arthritis in an Endemic Setting.
摘要(中文译文)
恙虫病是流行地区急性发热性疾病的常见病因；然而，其肌肉骨骼受累通常仅限于肌痛，真正的炎性关节炎鲜有报道。我们描述了一名既往健康的19岁男性新兵，其表现为为期两个月的进行性双膝肿胀和左踝疼痛，伴有发热、体重下降和淋巴结肿大。临床评估显示为炎性寡关节炎，滑液培养阴性。鉴于症状的慢性病程及全身表现，最初考虑结核性关节炎和化脓性关节炎。影像学显示关节结构保留，滑液分析显示炎性特征但无微生物生长。结核、自身免疫性疾病及其他热带感染的检查均为阴性。采用快速免疫层析法进行血清学检测，恙虫病免疫球蛋白M阳性。开始多西环素治疗后，患者临床迅速改善，发热消退，关节症状显著减轻。本病例突出了在流行地区恙虫病相关炎性寡关节炎模拟结核性关节炎的一种不常见表现。临床医生对于表现为发热性寡关节炎和培养阴性关节积液的患者应考虑恙虫病，因为早期识别和适当治疗可带来良好的结局。
Abstract
Scrub typhus is a common cause of acute febrile illness in endemic regions; however, musculoskeletal involvement is usually limited to myalgia, and true inflammatory arthritis is rarely reported. We describe a 19-year-old previously healthy male military recruit who presented with a two-month history of progressive bilateral knee swelling and left ankle pain, accompanied by fever, weight loss, and lymphadenopathy. Clinical evaluation revealed inflammatory oligoarthritis with culture-negative synovial fluid. Given the chronicity of symptoms and systemic features, tubercular and septic arthritis were initially considered. Imaging showed preserved joint architecture, and synovial fluid analysis demonstrated inflammatory features without microbial growth. Investigations for tuberculosis, autoimmune disorders, and other tropical infections were negative. Serological testing was positive for scrub typhus immunoglobulin M using a rapid immunochromatographic assay. Following the initiation of doxycycline therapy, the patient showed rapid clinical improvement with resolution of fever and marked reduction in joint symptoms. This case highlights an uncommon presentation of scrub typhus-associated inflammatory oligoarthritis mimicking tubercular arthritis in endemic regions. Clinicians should consider scrub typhus in patients presenting with febrile oligoarthritis and culture-negative joint effusion, as early recognition and appropriate treatment can result in excellent outcomes.
如何引用
AMA
Amrit K C, Suyesh Poudel, Adarsha Mahaseth, Raj Kumar Thapa, Rajiv Sitaula, Prakash Shrestha. Scrub Typhus-Associated Inflammatory Oligoarthritis Mimicking Tubercular Arthritis in an Endemic Setting.. Cureus. 2026; doi:10.7759/cureus.106318.
APA
Amrit K C, Suyesh Poudel, Adarsha Mahaseth, Raj Kumar Thapa, Rajiv Sitaula, Prakash Shrestha (2026). Scrub Typhus-Associated Inflammatory Oligoarthritis Mimicking Tubercular Arthritis in an Endemic Setting.. Cureus. https://doi.org/10.7759/cureus.106318
GB/T 7714
Amrit K C, Suyesh Poudel, Adarsha Mahaseth, Raj Kumar Thapa, Rajiv Sitaula, Prakash Shrestha. Scrub Typhus-Associated Inflammatory Oligoarthritis Mimicking Tubercular Arthritis in an Endemic Setting.[J]. Cureus, 2026 doi:10.7759/cureus.106318.
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