結核性肩峰下滑液包炎の１例

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Tuberculous subacromial bursitis is rare. We reported a case of subacromial bursitis with many loose bodies due to tuberculosis. A 59-year-old man was admitted with the complaint of swelling of the right shoulder of one months duration. The patient was not aware of any injury to the right shoulder, and did not have any arthritic symptoms. Physical examination revealed global swelling and fluctuation of the right shoulder without other inflammatory signs. The range of motion was full with normal muscle strength and without muscle atrophy. The leukocyte count was 4100 /μl, ESR 25 mm/hr, CRP 0.6 mg/dl, RF 0 IU/ml, and MMP-3 was 41.0 ng/ml. Radiographic study demonstrated erosion of the greater tuberosity without bone atrophy or destruction. Neither tear of the cuff nor other abnormal changes were detected by arthrography. T2-weighted MRI revealed a large mass of high intensity with multiple particles of slightly low intensity. No acid-fast bacteria were detected in the aspirate from the mass. Surgical exploration revealed a thickened subacromial bursa and a large number of corn-like loose bodies. Synovial proliferation was shown at the greater tuberosity. There was no communication to the glenohumeral joint and cuff was normal in appearance. Histological study of the bursa demonstrated the granulomatous change with epithelioid cells and Langhans giant cells, suggesting tuberculosis. Examination of QFT-Tb was positive and the patient was treated by antituberculous chemotherapy. Subacromial bursitis with many loose bodies is commonly found in rheumatoid arthritis. However, tuberculous subacromial bursitis should be considered as differential diagnosis.

結核性肩峰下滑液包炎の１例

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