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.