Mycobacterium tuberculosis
1 Department of Rheumatology, Chubu Rosai Hospital
2 Department of Surgery, Chubu Rosai Hospital
N.T, Takizawa, MD1 T.M, Mizutani, MD2 Y.F, Fujita, MD1
Naoho Takizawa, M.D.
Department of Rheumatology, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya 455-8530, Japan
TEL: +81-52-652-5511 FAX: +81-52-653-3533
E-mail:ttkkzzww5959@gmail.com
Tetsushi Mizutani, M.D.
Department of Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya 455-8530, Japan
TEL: +81-52-652-5511 FAX: +81-52-653-3533
E-mail: tetsushi_surg@yahoo.co.jp
Yoshiro Fujita, M.D.
Department of Rheumatology, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya 455-8530, Japan
TEL: +81-52-652-5511 FAX: +81-52-653-3533
E-mail: hujitay@gmail.com
Address correspondence to Naoho Takizawa, Department of Rheumatology, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya 455-8530, Japan
TEL: +52-652-5511 FAX: +52-653-3533
e-mail:ttkkzzww5959@gmail.com
An 83-year old woman presented with a left pericostal painful mass which she had had for a year. She was diagnosed with systemic sclerosis(SSc) by skin thickening and a positive result of anti-centromere antibody at age 75, however she didn’t take any immunosuppressants. An abdominal CT showed a pericostal mass (Figure1). We performed a needle biopsy, the result was negative for Ziehl-Neelsen stain, but both the PCR and culture of tuberculosis(TB) from the drain were positive. She was diagnosed with pericostal TB, and we started a combination treatment with isoniazid, rifampicin, pyrazinamide and ethambutol. Her chest pain resolved quickly and a repeat biopsy culture was done one month after initiation of treatment, the result was negative. Pericostal TB is a rare presentation of skeletal TB and is thought to be caused by an extension of a TB infection of the intercostal lymph nodes1. It has been reported that the risk of TB in SSc patients is 2.8 times higher than those in the general population2. The increased risk of developing TB in patients with autoimmune disorders may be due to an immune abnormality itself or immunosuppressants2. Regardless of immunosuppressant use, physicians should be aware of TB in SSc patients.
Ethics statement:
Written informed consent was obtained from the patient who participated in this study. This case report did not receive any funding. Authors have access to all source data for this case report.
Acknowledgements:
Published with written consent of the patient.
Conflict of interest:
None declared.
Author contributions:
Naoho Takizawa: wrote the initial draft, reviewed the literature, revised manuscript, and approved the final version.
Tetsushi Mizutani: reviewed the literature, revised manuscript.
Yoshiro Fujita: reviewed the literature, revised manuscript, and approved the final version.
Abstract
Autoimmune diseases including systemic sclerosis (SSc) increase risk of developing TB. Pericostal tuberculosis (TB) is a rare presentation of skeletal TB. This case report describes pericostal TB in a SSc patient, and emphasizes significance of suspecting pulmonary and extra-pulmonary TB when patients with autoimmune disease follow atypical clinical courses.
References
Prasoon D. Tuberculosis of the intercostal lymph nodes. Acta Cytol. 2003; 47: 51-55
Ou SM, Fan WC, Chou KT, et al. Systemic sclerosis and the risk of tuberculosis. J Rheumatol. 2014; 41: 1662-9
Figure
Abdominal contrast-enhanced CT
White arrow showed pericostal mass with central hypoattenuation.