A Case of Peripheral Bone Tuberculosis Mimicking Rheumatoid Arthritis

Kwak, Joo-Hee; Lee, Joo-Hyun; Kim, Sang-Heon; Joo, Kyung-Bin; Jun, Jae-Bum; Sung, Yoon-Kyoung

doi:2014.87.3.373

Korean J Med > Volume 87(3); 2014 > Article

Case Report

The Korean Journal of Medicine 2014;87(3):373-378.
Published online September 1, 2014.
DOI: https://doi.org/10.3904/kjm.2014.87.3.373

A Case of Peripheral Bone Tuberculosis Mimicking Rheumatoid Arthritis

Joo-Hee Kwak¹, Joo-Hyun Lee², Sang-Heon Kim¹, Kyung-Bin Joo³, Jae-Bum Jun^1,4, Yoon-Kyoung Sung^1,4

¹Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
²Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University Collee of Medicine, Goyang, Korea
³Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
⁴Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea

류마티스관절염 양상으로 발현된 말초 골결핵 1예

곽주희¹, 이주현², 김상헌¹, 주경빈³, 전재범^1,4, 성윤경^1,4

^¹한양대학교 의과대학 내과학교실
^²인제대학교 일산백병원 내과
^³한양대학교 의과대학 영상의학교실
^⁴한양대학교 류마티스병원 류마티스내과

Correspondence:
Yoon-Kyoung Sung, Tel: +82-2-2290-9250, Fax: +82-2-2298-8231, Email: sungyk@hanyang.ac.kr

Received: 20 September 2013 • Revised: 23 October 2013 • Accepted: 3 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 30 year-old female visited our out-patient clinic with painful joint swelling in both hands and feet. Because she had tested positive for rheumatoid factor, and her inflammatory markers were elevated, the case was initially classified as rheumatoid arthritis (RA), according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. However, radiographic examinations, including simple radiography and MRI, revealed that her peripheral bone lesions were compatible with bone tuberculosis. The patient also exhibited pulmonary tuberculosis (TB) on chest X-ray and CT examinations. She was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EMB), and pyrazinamide (PZA), and exhibited a good response to these medications. The patient was diagnosed as having bone TB, and her peripheral bone lesions were resolved using anti-TB treatment. This was an uncommon case of bone TB mimicking RA.

Key Words: Tuberculosis; Rheumatoid arthritis

주제어: 결핵; 류마티스관절염