結核性仙腸関節炎の１症例

Abstract

We experienced a case of tuberculous sacroiliitis. The patient was a 70-year-old woman. She suffered from general fatigue and febrile, but complained of no pain of the sacroiliac (SI) joint. She had slight tenderness over the right SI joint. Gaenslen test was negative. Roentgenogram revealed diffuse destruction with calcificated masses on the right SI joint. Laboratory on admittance showed no leukocytosis, elevation of erythrocyte sedimentation rate (125mm/hr) and C-reactive protein (3.79mg/dl). Results of the Mantoux test were positive. Needle biopsy from the right SI joint was performed, but the culture of specimens was negative and the pathological findings were not the specific results. We performed curettage and irrigation, and got the specimen of the bone involved. Histologic examination revealed granulomatous inflammation with infiltration of epitheloid cells, tubercle formation, caseous necrosis, and Langhans' giant cells. She was treated with three combined antituberculosis drugs (isoniazid, ethambutol, and rifampicin). At present 6 months after surgery, she has no pain, no fever and feels no fatigue.Sacroiliac joint involvement has been reported in 3-10 percent of patients with skeletal tuberculosis. Lack of awareness of this rare disease now often leads to diagnotic delay and increased morbidity. The direct sampling of the SI joint is necessary to establish the diagnosis. It is important to obtain the specimen involving oteoarticular fragments for the diagnosis.