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关节疼痛可为病毒感染的前躯症状。临床上约三分之一的乙型肝炎患者,在黄疸出现前有明显的风湿病症状。尽管如此,在急性多关节炎的鉴别诊断时,极少考虑乙型肝炎感染。乙型肝炎并发关节炎几乎总在黄疸出现之前,有时达几周,且可能是感染的唯一表现。作者报告3例具严重关节疼痛和乙型肝炎感染的患者,他们表现出这种重要的且常易误诊的特征性临床表现。病例1,女,28岁。4天前两侧肩关节剧烈疼痛,随后疼痛累及掌指(MCP)和近端指间(PIP)关节、肘、颌、腰椎、髋和膝关节。全身不适,近期无国外旅游、预防接种或滥用药物史。患者3个月前曾有性接
Joint pain can be a precursor to viral infection. About one-third of patients with hepatitis B have obvious symptoms of rheumatism before the onset of jaundice. In spite of this, hepatitis B infection is rarely considered in the differential diagnosis of acute polyarthritis. Hepatitis B complicated by arthritis is almost always present before jaundice, sometimes for weeks, and may be the only manifestation of infection. The authors report 3 patients with severe joint pain and hepatitis B infection who showed this characteristic and often misdiagnosed characteristic clinical presentation. Case 1, female, 28 years old. Severe pain in the shoulder joint on both sides 4 days ago, followed by pain involving the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, elbows, jaws, lumbar spine, hip and knee joints. Malaise, no recent foreign travel, vaccination or abuse of drugs history. Patient 3 months ago had sex before