Severe visual impairment and subclinical encephalitis preceding clinical signs of chondritis in relapsing polychondritis
Severe visual impairment and subclinical encephalitis preceding clinical signs of chondritis in relapsing polychondritis
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复发性多软骨炎中，严重视力障碍和亚临床脑炎先于软骨炎临床症状
DOI：
10.1111/ncn3.12243
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发表时间：
2018
影响因子：
0.4
通讯作者：
Toda Tatsushi
中科院分区：
文献类型：
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作者：
Miyano Ryoji;Kurihara Masanori;Orimo Kenta;Mano Tatsuo;Kaburaki Toshikatsu;Tanaka Rie;Nishijima Hironobu;Ikemura Masako;Takahashi Miwako;Mori Harushi;Mutoh Tatsuro;Hamada Masashi;Hayashi Toshihiro;Toda Tatsushi
1例71岁女性，有6个月复发性双侧前巩膜炎病史，因后巩膜炎出现重度右眼视力受损。尽管有脑炎的放射学体征，但患者及其家人未发现认知能力下降。患者随后出现轻微耳痛，无任何视觉变化，如发红或肿胀，但正电子发射断层扫描显示18 F-氟脱氧葡萄糖摄取增加。耳软骨活检显示软骨膜炎症提示复发性多囊炎。类固醇治疗改善了她的症状和放射学检查结果。这个病例说明，无症状的脑炎症病变可以先于复发性多囊炎的临床体征，即使有轻度的耳痛而无明显的炎症临床表现，也应该考虑耳软骨活检。
A 71‐year‐old woman with a 6‐month history of relapsing bilateral anterior scleritis presented with severe right visual impairment due to posterior scleritis. Despite radiological signs of encephalitis, the patient and her family members noticed no cognitive decline. The patient subsequently developed slight auricular pain without any visual changes such as redness or swelling, which, however, showed increased uptake of18F‐fluorodeoxyglucose on positron emission tomography. Auricular cartilage biopsy revealed perichondrial inflammation suggesting relapsing polychondritis. Steroid therapy improved her symptoms and radiological findings. This case illustrates that asymptomatic brain inflammatory lesions can precede clinical signs of chondritis in relapsing polychondritis, and that auricular cartilage biopsy should be considered even with mild auricular pain without apparent clinical findings of inflammation.