摘要
全身型幼年特发性关节炎是儿童常见的风湿免疫性疾病之一,起病急骤,全身症状明显,肺部也可累及,但以肺部磨玻璃影为早期表现且合并巨噬细胞活化综合征的全身型幼年特发性关节炎并不多见。现回顾性地分析华中科技大学同济医学院附属湖北妇幼保健院2021年12月收治的1例以肺部磨玻璃影为早期表现且合并巨噬细胞活化综合征的全身型幼年特发性关节炎患儿临床资料,以期提高对风湿性疾病合并肺部病变的认识。患儿因皮疹伴发热10 d入院,因新冠病毒肺炎疫情防控筛查行胸部CT发现双肺散在磨玻璃样影,入院后仍反复弛张高热,伴双下肢活动障碍,膝关节核磁共振发现膝关节存在滑膜炎表现,且各项实验室指标提示巨噬细胞活化综合征,后确诊全身型幼年特发性关节炎。给予甲基强的松龙、环孢素和托珠单抗等治疗,临床症状缓解且肺部磨玻璃影基本消失。通过对本病例的分析,提示临床医师在当前新型冠状病毒感染疫情期间,不可忽视引起肺部磨玻璃影的其他疾病。
Systemic juvenile idiopathic arthritis is one of the common rheumatic and immune diseases in children.It has a sudden onset,obvious systemic symptoms,and lung involvement.However,systemic juvenile idiopathic arthritis with an early manifestation of pulmonary ground-glass opacities combined with macrophage activation syndrome is rare.The clinical data of a child with systemic juvenile idiopathic arthritis with pulmonary ground-glass shadow and macrophage activation syndrome who was admitted to Hubei Maternal and Child Health Care Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology in December 2021 were analyzed retrospectively in order to improve the understanding of rheumatic diseases and pulmonary lesions.The child was admitted to the hospital for 10 days due to rash and fever.Thoracic CT showed scattered ground glass like shadows in both lungs due to the prevention and control screening of COVID-19 pneumonia epidemic situation.After admission,the child was still repeatedly flaccid with high fever,accompanied by dysfunction of both lower limbs.The knee joint MRI found that there was synovitis in the knee joint,and various laboratory indicators suggested macrophage activation syndrome.After that,systemic juvenile idiopathic arthritis was diagnosed.After being treated with methylprednisolone,cyclosporine and topzumab,the clinical remission and the ground-glass shadow of the lung basically disappeared.Through the analysis of this case,it is suggested that clinicians should not ignore other diseases that cause ground glass shadow in the lung during the current epidemic of COVID-19.
作者
谢静
李晓慧
朱松柏
吴晓林
郑荣浩
Xie Jing;Li Xiaohui;Zhu Songbai;Wu Xiaolin;Zheng Ronghao(Hubei University of Medicine,Shiyan 442000,China;Department of Pediatric Nephrology,Rheumatology,and Immunology,Maternal and Child Health Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430070,China.)
出处
《中国综合临床》
2023年第2期96-100,共5页
Clinical Medicine of China
