第5巻 2009年6月　第3号

■症例報告

関節リウマチに合併した非定型抗酸菌感染による手関節腱鞘滑膜炎の1例
森下　実¹, 平井　博¹, 吉岡　太郎¹, 立原　章年¹, 竹之内　研二¹, 中村　洋¹
日本医科大学大学院医学研究科神経・腎臓・膠原病リウマチ学
日本医科大学付属病院リウマチ科

A Case of Tenosynovitis Due to Mycobacterium abium Complex in a Patient with Rheumatoid Arthritis
Minoru Morishita¹, Hiroshi Hirai¹, Taro Yoshioka¹, Akitoshi Tachihara¹, Kenji Takenouchi¹ and Hiroshi Nakamura¹
Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School
Department of Joint Disease and Rheumatism, Nippon Medical School

Synovitis due to atypical mycobacteriosis is often difficult to diagnose, because it presents with nonspecific clinical findings. We describe a case of wrist tendon sheath synovitis due to atypical mycobacteriosis, which was complicated by rheumatic arthritis. The patient was a 66-year-old woman with rheumatic arthritis. She was found to have synovitis on the palmar side of the right wrist in June 2006 and underwent synovectomy. Pathological examination of the synovial tissue extracted during surgery showed, only findings of rheumatic arthritis, and atypical mycobacteriosis was not diagnosed. Because swelling recurred after surgery, we performed synovectomy a second time. Culture for bacterial and, the tubercle bacillus and the polymerase chain reaction for atypical mycobacteriosis were all negative. Swelling recurred after the second synovectomy. Mycobacterium avium and, Mycobacterium intracellulare were identified in fluid obtained from puncture of the swollen wrist area, therefore, we started chemotherapy and performed synovectomy a third time. Swelling has not recurred in the year since the third synovectomy was performed. We believe that atypical mycobacteriosis should be considered when intractable wrist tendon sheath synovitis occurs.

日医大医会誌 2009; 5(3), 172-175

Key words
rheumatic arthritis, synovitis, atypical mycobacteriosis

Correspondence to
Minoru Morishita, Department of Joint Disease and Rheumatism, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：minoru3420@mail.goo.ne.jp

受付：2009年3月4日　受理：2009年4月7日