A 26-Year-Old Man with Sternoclavicular Arthritis 英文参考文献.docVIP

Learning Forum A 26-Year-Old Man with Sternoclavicular Arthritis Christian Gutierrez Ruiz , J. Jaime Miranda, Georgios Pappas * D E S C R I P T I O N o f C A S E A 26-year-old man presented to the Hospital San Juan de Matucana, Lima, Peru, with a two-week history of fever, myalgias, and arthralgia of the left hip and right sternoclavicular joint. On clinical examination, localized tenderness over the sacroiliac joint and reproduction of Gaenslen’s sign (lumbosacral tenderness on hip hyperextension with contralateral hip ?exion) and Patrick’s sign (localized pain on ?exion, abduction, and external rotation of ipsilateral hip) were suggestive of sacroiliitis. The sternoclavicular joint was tender on palpation, but there was no overlying erythema or edema. DOI: 10.1371/journal.pmed.0030293.g001 Figure 1. Plain Radiograph of the Sacroiliac Joints on Presentation to the Hospital San Juan de Matucana The radiologist reported this radiograph as normal. Four months prior to presentation, the patient had been diagnosed with brucellosis following the consumption of non-pasteurized goat cheese in Huarochiri, an area within the Sierra of Lima that is hyperendemic for brucellosis. At presentation to the Hospital San Juan de Matucana, no data were available on the accuracy of the diagnostic methods used to make a diagnosis of brucellosis. The patient did not recall any joint symptoms when he had ?rst been diagnosed with brucellosis. He reported that he was treated with oral rifampin 900 mg and doxycycline 200 mg daily for ?ve weeks, with rapid resolution of his symptoms. disease, one would expect a more severe clinical presentation. The same is true for streptococcal infections. Nevertheless, staphylococcal arthritis may sometimes follow an indolent course, and an entry point or event may not be present in the history, and so staphylococcal arthritis was a possibility in this patient. Typhoid is endemic to many parts of Peru, and so was another diagnostic possibility. The p