FMF Hastasında Aseptik Temporomandibular Eklem Sinoviti ile birlikte Seyreden Yaygın Enflamasyon: Vaka Raporu

Year 2022, Volume: 7 Issue: 1, 31 - 36, 01.04.2022

Kıvanç Berke Ak , Muazzez Suzen , Sina Uçkan

Abstract

Özet:
Ailevi Akdeniz ateşi (FMF), kendini sınırlayan, provoke edilmemiş ateşli ve poliserozit ataklarıyla karakterize sistemik otoinflamatuar hastalıktır. Temporomandibular eklem (TME) tutulumu nadir olsada, yaşam kalitesini önemli ölçüde düşer ve bazı hastalıklar ile benzer semptomlar nedeniyle yanlış teşhis edilebilir. Birkaç vakada farklı cerrahi yaklaşımlar bildirilmesine ragmen, kabul edilmiş tedavi yöntemi yoktur.
Olgu Sunumu
Şiddetli unilateral TME bölgesi ağrısı ve ağız açıklığında kısıtlılık nedeni ile 11 yaşında kadın hasta merkezime baş vurmuştur. Alınan anemnezde kolşisin tedavisi altında olmasına rağmen ayda bir FMF atakları geçirdiği bildirilmiştir. Radyoloji departmanı konsültasyonu sonrası kontrastlı manyetik rezonans görüntüleme (MRI) gerçekleştirildi. MRG raporunun septik artrit ve osteomiyelit gibi enfektif hastalıklara yönlendirmesine rağmen, FMF ataklarının sıklığı nedeniyle diğer enflamatuar süreçler yeniden değerlendirildi. Lokal anestezi altında bakteriyolojik inceleme amaçlı sinovyal sıvı alındı. Artrosentez sonrası semptomlarda hızlı bir rahatlatama gözlemlendi. Sinovyal sıvı incelemesinde bakteri üremesi tespit edilmedi. Kolşisin doz ayarlaması ile altı aylık takipte FMF atağı gözlenmedi ve ilave operasyona ihtiyaç duyulmadı.
SONUÇ
FMF'e bağlı TME artriti çok nadir görülür ve diğer hastalıklarla örtüşen semptomlar yanlış tanıya yol açabilir. Bu durumun tedavisi ile ilgili bir görüş birliği yoktur. Akut ve subakut semptomlar, kolşisin dozunun artırılması ve artrosentez gibi non-invaziv yöntemlerle hızlı bir şekilde giderilebilir.

Keywords

Temporomandibular eklem, aseptik artrit, Ailevi Akdeniz Ateşi

Aseptic Arthritis of the Temporomandibular Joint with Severe Inflammation in an FMF Patient: A Case Report

Abstract

BACKGROUND
Familial Mediterranean fever (FMF) is a systemic autoinflammatory disorder characterized by self-limited unprovoked inflammatory attacks of fever and polyserositis. Although temporomandibular joint (TMJ) involvement is uncommon, it significantly reduces the quality of life and could be easily misdiagnosed due to overlapping symptoms. Only a few cases have been reported with different surgical approaches, but there are no specific treatment guidelines.
CASE SUMMARY
The case of an 11-year-old female FMF patient with severe unilateral TMJ region pain and limited maximum mouth opening is presented. Although the patient was under colchicine treatment, the frequency of FMF attacks was once a month. After consultation with the radiology department, contrast-enhanced magnetic resonance imaging (MRI) was performed. The differential diagnosis of the MRI report was infectious processes (septic arthritis and osteomyelitis). Nevertheless, other inflammatory processes were evaluated due to the frequency of FMF attacks. Under local anesthesia, synovial fluid was taken for bacteriological examination, and arthrocentesis was performed. Symptoms were relieved immediately after the operation. Bacterial growth was not detected on synovial fluid examination. No new FMF attacks were reported, and no new operations were needed in the six-month follow-up with colchicine dosage adjustment.
CONCLUSION
TMJ arthritis due to FMF is seen very rarely, and overlapping symptoms could lead to misdiagnosis. Although there is no consensus regarding the treatment of TMJ arthritis, acute and subacute symptoms could be relieved very quickly with less invasive methods, such as increasing the dose of colchicine and arthrocentesis.

Keywords

Temporomandibular joint, aseptic arthritis, Familial Mediterranean fever, Temporomandibular joint, aseptic arthritis, Familial Mediterranean fever

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