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表1 2011—2026年类似RA表现的M. marinum感染病例的临床资料
Table 1 Clinical characteristics of M. marinum infection mimicking RA，2011—2026

Immunosupp res⁃ Diagnostic
First author，year Involved site Treatment Outcome
sive agents used method
Thanou ⁃ Stavraki Bilateral wrist joints，fourth MTX，ETN，HCQ，Tissue culture ITZ，CLM，EMB Clinical remission
A ［21］ ，2011 and fifth MCP joints，and ADA，INF，LEF
the left fourth PIP joint
Macek P ［22］ ，2011 MCP joints of the index，MTX PCR，tissue culture，CPF，EMB，AMK，Not described
middle，and ring fingers， MGIT culture PZA，Cs，lesion
right testicle excision surgery
［23］
Furer V ，2012 MCP joints of the right ⁃ - Tissue culture Not described Not described
hand index，middle，and
little fingers
［24］
Slany M ，2013 Index finger，ring finger MTX PCR，tissue culture AMK，CPF，EMB，Still recovering
joints and bones，forearm， PZA，Cs，lesion
testicles，and epididymis excision surgery
Flondell M ［25］ ，MCP joints of the ring - Tissue culture CLM，lesion exci⁃ Clinical remission
2013 finger and index finger sion surgery
［26］
Papathemeli D ，Calves，thighs，right knee，LEF，AZA PCR，tissue culture EMB，CLM，RMP Stabilization of the
2016 and arms disease
Lata C J ［27］ ，2017 Left wrist，MCP joints， ADA，MTX，LEF，MGIT culture CLM，MFX，lesion Complete remis⁃
elbow，and left knee SSZ excision surgery sion of the disease
without recurrence
Shahriari N ［28］ ， Right hand and forearm MTX，LEF，ETN，Tissue culture EMB，RMP，AZM Not described
2019 INF
［29］
Schubert N ， The third and fourth MCP MTX，SSZ，HCQ，Tissue culture CLM，RMP Clinical remission
2020 joints and IP joints LEF
Joyo Y ［30］ ，2023 IP joint of the right thumb，MTX Tissue culture RMP，EMB，CLM No recurrence ob⁃
PIP joint of the right ring served
finger，and right palm
MCP：metacarpophalangeal；PIP：proximal interphalangeal；MTX：Methotrexate；ETN：etanercept；HCQ：hydroxychloroquine；ADA：adalimumab；
INF：infliximab；LEF：leflunomide；ITZ：itraconazole；CLM：clarithromycin；EMB：ethambutol；MGIT：mycobacterial growth indicator tube；CPF：
ciprofloxacin；AMK：amikacin；PZA：pyrazinamide；Cs：cycloserine；AZA：azathioprine；RMP：rifampicin；SSZ：sulfasalazine；MFX：moxifloxacin；IP：
interphalangeal；AZM：azithromycin.

Consider tissue
Empirical
culture and
therapy No MDT assessment
molecular biology
examination
History and Imaging Differential
Confident
clinical examination diagnosis Assessment of infection severity and risk of
diagnosis ？
examination and blood test MDT assessment spread：
Imaging examinations（X⁃ray/Ultasound/MRI）
Yes
Exclusion of complications：
Imaging examinations and electromyography
Formulation of treatment plan：
Selection of antibiotic regimen
Collaborative management of underlying
conditions with specialists
Rehabilitation exercises
This workflow highlights the pivotal role of a multidisciplinary team（MDT）in the diagnosis of complex infectious diseases. Because M. marinum is
slow⁃growing and requires specific culture conditions，a high index of clinical suspicion is essential to trigger targeted sampling and testing. PCR：
polymerase chain reaction；MRI：magnetic resonance imaging；mNGS：metagenomic next⁃generation sequencing.
图4 疑似M. marinum感染的诊断流程
Figure 4 Suspected M. marinum infection diagnostic workflow