The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Musculoskeletal Tuberculosis Mimicking Adult-Onset Still's Disease

성인형 스틸병과 유사한 임상양상을 보인 다발성 골 결핵 1예

  • Cho, Jin Kyeong (Department of Internal Medicine, Seoul Medical Center) ;
  • Kim, Min Sung (Department of Internal Medicine, Seoul Medical Center) ;
  • Shin, Jin Ho (Department of Internal Medicine, Seoul Medical Center) ;
  • Jeong, Yeon Sang (Department of Internal Medicine, Seoul Medical Center) ;
  • Kim, Joon Wan (Department of Internal Medicine, Seoul Medical Center) ;
  • Choi, Jae Phil (Department of Internal Medicine, Seoul Medical Center) ;
  • Choi, Byoong Yong (Department of Internal Medicine, Seoul Medical Center)
  • 조진경 (서울특별시 서울의료원 내과) ;
  • 김민성 (서울특별시 서울의료원 내과) ;
  • 신진호 (서울특별시 서울의료원 내과) ;
  • 정연상 (서울특별시 서울의료원 내과) ;
  • 김준완 (서울특별시 서울의료원 내과) ;
  • 최재필 (서울특별시 서울의료원 내과) ;
  • 최병용 (서울특별시 서울의료원 내과)
  • Received : 2013.08.13
  • Accepted : 2013.10.16
  • Published : 2014.06.01
⟨ Previous Next ⟩

Abstract

A 46-year-old man was admitted to our hospital because of a fever of unknown origin. The patient had a skin rash, arthralgia, and hepatosplenomegaly. Laboratory tests showed leukemoid leukocytosis, a high serum ferritin level (31,200 ng/mL), and abnormal liver function tests. He was initially diagnosed with adult-onset Still's disease (AOSD). However, imaging studies incidentally detected a cold abscess involving the 11th thoracic vertebra. A biopsy of the abscess revealed histologically granulomatous caseous necrosis, positive for M. tuberculosis by polymerase chain reaction. We present a patient with musculoskeletal tuberculosis (TB) that clinically mimicked AOSD. In TB-endemic countries, extrapulmonary TB should be included in the differential diagnosis of AOSD.

저자들은 전신 오한, 피부 발진과 관절통 등을 동반한 원인불명열 환자에서 성인형 스틸병으로 의심하였으나 흉추와 경골을 침범한 골 결핵으로 최종 진단된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Cagatay Y, Gul A, Cagatay A, et al. Adult-onset Still's disease. Int J Clin Pract 2009;63:1050-1055. https://doi.org/10.1111/j.1742-1241.2007.01393.x
  2. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill, 2012.
  3. Korea Centers for Disease Control and Prevention. Joint Committee for the Development of Korean Guidelines for Tuberculosis: Korean Guidelines for Tuberculosis. 1st ed. Changwon: Korea Centers for Disease Control and Prevention, 2011.
  4. Kee SY, Jo YM, Kim JY, et al. Etiology of adult patients with fever of unknown origin (FUO) observed in a university hospital in Korea from 1998-2003. Infect Chemother 2005;37:127-132.
  5. Hong L, Wu JG, Ding JG, et al. Multifocal skeletal tuberculosis: experience in diagnosis and treatment. Med Mal Infect 2010;40:6-11. https://doi.org/10.1016/j.medmal.2009.03.004
  6. Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician 2005;72:1761-1768.
  7. Kroot EJ, Hazes JM, Colin EM, Dolhain RJ. Poncet's disease: reactive arthritis accompanying tuberculosis: two case reports and a review of the literature. Rheumatology (Oxford) 2007;46:484-489. https://doi.org/10.1093/rheumatology/kel268
  8. Bravo FG, Gotuzzo E. Cutaneous tuberculosis. Clin Dermatol 2007;25:173-180. https://doi.org/10.1016/j.clindermatol.2006.05.005
  9. Lian F, Wang Y, Yang X, Xu H, Liang L. Clinical features and hyperferritinemia diagnostic cutoff points for AOSD based on ROC curve: a Chinese experience. Rheumatol Int 2012;32:189-192. https://doi.org/10.1007/s00296-010-1601-4
  10. Manoj EM, Srigrishna R, Ragunathan MK. Hepatic tuberculosis presenting with extreme hyperferritinemia masquerading as adult-onset Still's disease: a case report. J Med Case Rep 2012;6:195. https://doi.org/10.1186/1752-1947-6-195