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Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report

BACKGROUND: Unusual forms of tuberculosis are common among immune-suppressed patients, leading to challenges in diagnosis and management. We present a Sri Lankan patient with systemic lupus erythematosis, investigated for chronic wrist pain with low inflammatory markers and without systemic symptoms...

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Autores principales: Luke, W. A. N. V., Gunathilake, M. P. M. L., Munidasa, Duminda, Munidasa, Dilshan, De Silva, S. T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534038/
https://www.ncbi.nlm.nih.gov/pubmed/28754137
http://dx.doi.org/10.1186/s13104-017-2629-2
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author Luke, W. A. N. V.
Gunathilake, M. P. M. L.
Munidasa, Duminda
Munidasa, Dilshan
De Silva, S. T.
author_facet Luke, W. A. N. V.
Gunathilake, M. P. M. L.
Munidasa, Duminda
Munidasa, Dilshan
De Silva, S. T.
author_sort Luke, W. A. N. V.
collection PubMed
description BACKGROUND: Unusual forms of tuberculosis are common among immune-suppressed patients, leading to challenges in diagnosis and management. We present a Sri Lankan patient with systemic lupus erythematosis, investigated for chronic wrist pain with low inflammatory markers and without systemic symptoms, who was subsequently diagnosed to have tuberculosis of the joint. CASE PRESENTATION: A 31-year-old woman with systemic lupus erythematosis in remission was evaluated for chronic left wrist pain without significant examination findings on presentation. She did not have any constitutional symptoms. Basic investigations did not reveal any significant abnormalities. She was treated with increasing immunosuppression as for lupus related arthritis. Subsequently she developed a wrist effusion with high inflammatory markers, and was treated as septic arthritis. Synovial biopsy features suggested tuberculosis. The patient’s symptoms improved with surgical intervention and anti-tuberculosis treatment. CONCLUSION: Tuberculosis should be considered in patients with systemic arthritis with unusual symptoms. Delayed diagnosis along with continuing immunosuppression can lead to extensive tissue damage. Clinically detectable effusions should be analyzed along with synovial biopsy in order to exclude concurrent infections. Radiography of the joint has poor sensitivity to detect early joint damage, but changes may be evident early on magnetic resonance imaging, sothis should be considered in patients with unusual features.
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spelling pubmed-55340382017-08-03 Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report Luke, W. A. N. V. Gunathilake, M. P. M. L. Munidasa, Duminda Munidasa, Dilshan De Silva, S. T. BMC Res Notes Case Report BACKGROUND: Unusual forms of tuberculosis are common among immune-suppressed patients, leading to challenges in diagnosis and management. We present a Sri Lankan patient with systemic lupus erythematosis, investigated for chronic wrist pain with low inflammatory markers and without systemic symptoms, who was subsequently diagnosed to have tuberculosis of the joint. CASE PRESENTATION: A 31-year-old woman with systemic lupus erythematosis in remission was evaluated for chronic left wrist pain without significant examination findings on presentation. She did not have any constitutional symptoms. Basic investigations did not reveal any significant abnormalities. She was treated with increasing immunosuppression as for lupus related arthritis. Subsequently she developed a wrist effusion with high inflammatory markers, and was treated as septic arthritis. Synovial biopsy features suggested tuberculosis. The patient’s symptoms improved with surgical intervention and anti-tuberculosis treatment. CONCLUSION: Tuberculosis should be considered in patients with systemic arthritis with unusual symptoms. Delayed diagnosis along with continuing immunosuppression can lead to extensive tissue damage. Clinically detectable effusions should be analyzed along with synovial biopsy in order to exclude concurrent infections. Radiography of the joint has poor sensitivity to detect early joint damage, but changes may be evident early on magnetic resonance imaging, sothis should be considered in patients with unusual features. BioMed Central 2017-07-28 /pmc/articles/PMC5534038/ /pubmed/28754137 http://dx.doi.org/10.1186/s13104-017-2629-2 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Luke, W. A. N. V.
Gunathilake, M. P. M. L.
Munidasa, Duminda
Munidasa, Dilshan
De Silva, S. T.
Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
title Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
title_full Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
title_fullStr Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
title_full_unstemmed Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
title_short Tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
title_sort tuberculous monoarthritis of the wrist in a patient with systemic lupus erythematosus: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534038/
https://www.ncbi.nlm.nih.gov/pubmed/28754137
http://dx.doi.org/10.1186/s13104-017-2629-2
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