在假肢关节中揭露结核性关节炎:诊断和治疗方面的挑战
Asbah Rahman1, Aastha Randhawa1, Yu Shia Lin1
1Maimonides Medical Center, Brooklyn, NY, USA.
IDCases
|January 13, 2025
概括
在假膝关节中诊断结核病具有挑战性,特别是在老年患者中. 这一案例显示,尽管膝盖疼痛和胀的初始症状,但结核假肢关节感染的延迟诊断.
科学领域:
- 整形外科 整形外科 整形外科
- 传染性疾病 传染性疾病
- 类风湿病学 类风湿病学
背景情况:
- 患有假肢关节置换的老年患者可能会出现持续的膝盖疼痛和胀.
- 最初的诊断可能是误导性的,延迟了假肢关节感染的适当治疗.
研究的目的:
- 为了突出结核假肢关节感染在老年患者的诊断挑战.
- 强调在假肢关节感染中考虑不常见病原体的重要性.
主要方法:
- 一个85岁的老妇人的案例研究,她曾经进行过全膝关节置换.
- 来自关节切开术的突液分析,包括白细胞计数和差异化.
- 细菌,真菌和酸性细菌 (AFB) 培养的突液.
- 使用MALDI-TOF质谱仪确认了Mycobacterium结核综合体.
主要成果:
- 该患者出现了14个月的左膝盖胀和疼痛,最初被诊断为突囊.
- 重复的关节切口检查显示白血球数量升高,中性和淋巴细胞占主导地位.
- 对细菌和真菌的突液培养是负的.
- AFB培养物发现了Mycobacterium结核复合体,由MALDI-TOFMS证实.
结论:
- 结核假肢关节感染可以模仿其他疾病,导致诊断延迟.
- 在假肢关节感染时,应考虑感染Mycobacterium tuberculosis,特别是在症状持久的老年人中.
- 先进的诊断技术对于识别具有挑战性的假肢关节感染至关重要.
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