布鲁氏菌性关节炎一例并文献复习

Brucellar Arthritis: A Case Report and Literature Review

摘要: 目的：报道1例以肩关节肿痛为首发症状的布鲁氏菌病病例，总结布鲁氏菌性肩关节炎的临床特征，提高临床医师对该病的认识。方法：回顾性分析1例老年女性布鲁氏菌性肩关节炎患者的临床资料，包括临床表现、实验室检查、影像学特征、病理结果、治疗方案及预后，并系统回顾近15年布鲁氏菌性关节炎相关文献，进行分析讨论。结果：患者以右肩关节肿痛伴活动受限1月余入院，实验室检查显示炎症指标升高，血沉78.00 mm/h，C反应蛋白25.59 mg/dL；影像学检查提示右肩关节囊及滑囊肿胀积液，滑膜增厚；关节液培养确诊为布氏杆菌感染。患者接受关节镜下病损清除术联合多西环素、利福平及头孢曲松钠三联抗生素治疗，术后症状明显缓解。术后6个月随访，患者右肩关节功能恢复良好，无复发迹象，血沉及C反应蛋白均恢复正常。结论：布鲁氏菌性关节炎临床表现缺乏特异性，肩关节炎较脊柱及髋膝关节受累少见，易误诊为结核性关节炎、化脓性关节炎或肿瘤性病变。在非传统流行区尤易漏诊，详细询问流行病学史(特别是生鲜、奶制品摄入史)、血清学检查及病原学检查是确诊的关键。早期诊断和规范的抗生素治疗联合必要的手术干预可获得良好预后。

Abstract: Objective: To report a case of brucellosis presenting with shoulder joint pain and swelling as the initial symptom, summarize the clinical characteristics of brucellar shoulder arthritis, and improve clinical awareness of this disease. Methods: A retrospective analysis was conducted on the clinical data of an elderly female patient with brucellar shoulder arthritis, including clinical manifestations, laboratory examinations, imaging characteristics, pathological results, treatment plan, and prognosis. A systematic literature review of brucellar arthritis cases published in the past 15 years was performed for discussion. Results: The patient presented with right shoulder joint swelling, pain, and limited range of motion for more than one month. Laboratory tests showed elevated inflammatory markers with ESR of 78.00 mm/h and CRP of 25.59 mg/dL. Imaging revealed swelling and effusion of the right shoulder joint capsule and bursa, with synovial thickening. Joint fluid culture confirmed brucellosis. The patient underwent arthroscopic debridement combined with a triple antibiotic regimen of doxycycline, rifampin, and ceftriaxone sodium. Postoperatively, symptoms significantly improved. At 6-month follow-up, the patient demonstrated good recovery of shoulder joint function without recurrence, and both ESR and CRP returned to normal levels. Conclusion: The clinical presentation of brucellar arthritis is non-specific, and shoulder arthritis is less common than spinal and hip-knee involvement, which can easily be misdiagnosed as tuberculous arthritis, pyogenic arthritis, or neoplastic lesions. It is particularly prone to missed diagnosis in non-traditional endemic areas. A thorough epidemiological history (especially regarding consumption of raw meat and dairy products), serological testing, and pathogen examination are essential for diagnosis. Early diagnosis and standardized antibiotic treatment combined with necessary surgical intervention can lead to a favorable prognosis.