Tuberculosis presenting as polyarthritis.
نویسندگان
چکیده
A 34 years female was referred with a history of intermittent low to high grade fever with characteristic evening rise alongwith joint pains. There was symmetrical involvement of both small and largejoints of the body overthe preceding 6 months, with deterioration over preceding month so much so that she could not walk and became bed bound. The patient reported that her joints were stiff on waking. She did not have any rash or night sweats but hadaweight loss of 15kg over this period. She had used various medicines including herbal without relief, On examination, she was febrile (39°C) thin and weak. Her blood pressure was 100/70 mm Hg and a pulse 120/rn, respiratory rate was 24/mm. Few small left posterior ceivical lymph nodes were palpable. On musculoskeletal examinatkn, she was unable to make fists and range of movements were restricted in all joints. There were no signs of inflammationordeformities, crepituswasfelt in the left knee and there was generalized wasting more so of small muscles of the hands. Laboratory tests showed Hemoglobin of 8.5 g/dI, white blood cells 7000/cm, platelet count 604xlOE9fl. Liver and renal function tests were normal, ESR was 116 m.m/hr. Urine analysis showed 3 RBC’s. Her A.N.A., A.M.A., A.S.M.A. and ANTI-DNA were negative and RA factor was also negative. Thyroid function tests were normal. Serum Albumin was 2.3 gm/dl with a Globulin of 5.9 gm/dl. Chest X-ray was normal. X-ray of hands showed periarticular osteopema and bony erosions involving metacarpophalangeal and phalangeal joints. She was discharged with the diagnosis of sero negative rheumatoid arthritis on non steroidal anti inflammatory drugs. Ten days later she was admitted again with high grade fever and neck rigidity. CSF examination, showed glucose of 94 mg/dl, protein2O4.8 mg/dl, Cl122 mm/I, TLC-14/cmni, N-l0/cmm, L-90/cmrn, RBC’s 36/cmm. She was started on anti tuberculous therapy, antibiotics and steroids. Her urine, blood and CSF cultures were negative for AFB and fungus. She gradually improved and was discharged. At subsequent visits her steroids were gradually tapered and then stopped. Her temperature settled, joints pain subsided and she was mobile and gained weight.
منابع مشابه
Skin Tuberculosis presenting as a Tinea Incognito-like eruption: A case report
Lupus vulgaris is a progressive form of skin tuberculosis occurring in the patients with a moderate to high degree of immunity. It is reported to be the commonest type of skin tuberculosis. Our case was a 40 year-old man who referred with multiple, erythematous, annular plaques, 30-50 mm in diameter with active margin and few studded pustules throughout the lesions. Our first impression was tin...
متن کاملChronic slowly progressive monoarthritis tuberculosis of the hip without systemic symptoms mimicking osteoarthritis: a case report
The authors report and discuss the clinical and radiological features of a immunocompetent patient with chronic progressive monoarthritis tuberculosis of the hip without systemic symptoms such as fever, and weight loss presenting as caseating abscess and severe destruction of the hip joint, treated with resection arthroplasty.
متن کاملThyroid Tuberculosis Presenting as a Cystic Nodule
Although tuberculosis involves every organ and has a wide range of clinical manifestation, however involvement of the thyroid gland is rare. We report a case of a 25-yr-old female with supraclavicular lymphadenitis that developed nodular swelling of the thyroid and had symptoms and sonographic features mimicking a nodule with a cystic component. The diagnosis was made by using fine needle aspir...
متن کاملIsolated Sternal Tuberculosis Presenting as a Chest Wall Abscess: A Case Report
In India, pulmonary tuberculosis accounts for 85% of cases and extrapulmonary tuberculosis accounts for 15% of cases with bone and joint involvement is seen in 1 to 3% of cases. Primary tuberculous osteomyelitis of the sternum is a rare form of extrapulmonary tuberculosis. A 51-year-old male presented with 10 years history of swelling over the anterior chest wall and pain for past 6 months. Fin...
متن کاملSkeletal Tuberculosis Presenting as a Small Cystic Lesion in the Medial Femoral Condyle
Skeletal tuberculosis is an unusual disease involving bone and joints and it may have different manifestations. This report introduces a 25-year-old woman suffering from chronic knee pain without any response to conservative treatments for one year. X-ray was normal but CT-scan and MRI indicated a small lesion in medial condyle of the femur. The patient underwent percutaneous CT-guided biopsy...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- JPMA. The Journal of the Pakistan Medical Association
دوره 48 6 شماره
صفحات -
تاریخ انتشار 1998