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患者女性,54岁,农民。1981年5月底开始渐起四肢无力伴轻度酸痛,以两下肢明显。继之说话含糊不清和吞咽呛咳。曾误诊为重症肌无力。7月14日入院。检查:两眼视力及眼底正常。讲话鼻音,两侧软腭运动较差,咽反射迟钝。四肢肌力近端3度远端4度,两下肢较上肢为重,肌肉有压痛无明显萎缩未扪及结节。深浅感觉和腱反射正常。无小脑征和脑膜刺激征。血CPK,血钙,硷性磷酸酶,肝肾功能正常。CSF 常规、生化、免疫球蛋白和胶金试验正常,CSF未见寡克隆带。EKG,EEG,胸部X 线片和脑CT 正常。EMG 示肌原性损害。肌肉活检:肌纤维间可见散在性边界清楚的小肉芽肿结构,其中央无干酪坏死区,见郎罕氏巨细胞及许多类上皮细胞,外周有淋巴细胞浸润及少量增生的成纤维细胞,炎症细胞中偶见单核细胞、中性粒细胞,肉芽肿使周围的肌纤维受压或破坏。各处肌纤维间亦可见散在淋巴细胞浸润及肌膜核增生和内移。病理诊断:结节病性肉芽肿性肌炎。经激素等治疗41天显著进步出院。讨论本病甚罕见,国内迄今尚未见报导。曾报导结节病性肌肉损害占10～20%。
Female patient, 54 years old, farmer. The end of May 1981 gradually began to weakness with mild pain, both lower extremity obvious. Followed by vague ambiguity and swallowing cough. Have misdiagnosed as myasthenia gravis. July 14 admission. Check: Both eyesight and fundus normal. Nasal tone, poor soft palate movement on both sides, pharyngeal reflex slow. 3 degrees proximal limb distal muscle 4 degrees, two lower limbs than the upper limbs, muscle tenderness no obvious atrophy not palpable nodules. Shade feeling and tendon reflexes normal. No signs of cerebellar and meningeal irritation. Blood CPK, blood calcium, alkaline phosphatase, liver and kidney function is normal. CSF routine, biochemical, immunoglobulin and plastic gold test was normal, no oligoclonal bands CSF. EKG, EEG, chest X-ray and brain CT normal. EMG showed myogenic damage. Muscle biopsy: muscle fiber interspersed with clear boundaries of small granuloma structure, the central cheese necrosis area, see Langerhans giant cells and many types of epithelial cells, peripheral lymphocyte infiltration and a small amount of proliferation of fibroblasts, inflammatory cells Occasionally monocytes, neutrophils, granulomas around the muscle fibers compression or damage. Around the muscle fibers are also seen scattered lymphocyte infiltration and myometrial proliferation and internal migration. Pathological diagnosis: sarcoidosis myositis. 41 days after hormone therapy significantly improved discharge. Discussion of the disease is very rare, so far no reports in the country. Nodular muscle lesions have been reported 10 to 20%.