临床误诊误治2024，Vol.37Issue(11)：1-5,5.DOI:10.3969/j.issn.1002-3429.2024.11.001
不典型强直性脊柱炎误诊原因分析
Causes of Misdiagnosis of Atypical Ankylosing Spondylitis
摘要
Abstract
Objective To analyze the causes and preventive measures of ankylosing spondylitis(AS)misdiagnosed as lumbar disc herniation(LDH)and rheumatic fever(RF).Methods The case data of 1 patient with AS misdiagnosed as LDH and 1 patient with RF from 2021 to 2023 were retrospectively analyzed.Results A 31-year-old male patient presented with pain in the lower back and right lower extremity accompanied by morning stiffness for 3 months.CT examination of lumbar disc showed mild disc herniation at L4-5 and was initially diagnosed as LDH.Afterwards,low fever appeared,erythrocyte subsidence rate(ESR)and C-reactive protein(CRP)were elevated,human leukocyte antigen B27(HLA-B27)was positive,and CT scan of the sacroiliac joint showed worm-eaten-like changes on the surface of both sacroiliac joints,which was diagnosed AS.One pa-tient was a 16-year-old adolescent who presented with swelling and pain in both ankles and knees for more than 1 year,which was aggravated for more than 1 month.Due to anti-streptolysin"O"test(+),and the complicated symptoms of multiple joint pain,he was diagnosed with RF.The symptoms improved after Benzathine Penicillin injection and recurred after discontinua-tion.MRI examination of posterior sacroiliac joint showed local fusion of bilateral sacroiliac joint surfaces,with elevated ESR and CRP.Based on this,AS was diagnosed after exclusion of RF.The duration of misdiagnosis was 3 months and 14 months re-spectively.After diagnosis,the symptoms of 2 patients disappeared after treatment with Sulfasalazine,Methotrexate,and recombi-nant human tumor necrosis factor receptor type Ⅱ antibody fusion protein.They were followed up for 1 to 2 years,and the con-dition was stable.Conclusion Some patients with AS have atypical manifestations in the early stage and are prone to misdiag-nosis.Strengthening the understanding of AS and related diseases,diagnosis and differential diagnosis ability,careful collec-tion of medical history,careful physical examination,early imaging examination of sacroiliac joint and HLA-B27 detection,com-bined with clinical manifestations and other relevant examination results,can help avoid misdiagnosis of this disease.关键词
强直性脊柱炎/误诊/椎间盘突出/风湿热/HLA-B27/红细胞沉降率/鉴别诊断Key words
Ankylosing spondylitis/Misdiagnosis/Intervertebral disc herniation/Rheumatic fever/HLA-B27/Erythro-cyte sedimentation rate/Differential diagnosis分类
临床医学引用本文复制引用
李祎,李奎蒙,冯会成..不典型强直性脊柱炎误诊原因分析[J].临床误诊误治,2024,37(11):1-5,5.基金项目
河北省卫生健康委医学科学研究课题(20221901) （20221901）
