Tuberculous pyomyositis in a rheumatoid arthritis patient treated with anakinra

Michael P Migkos; George A Somarakis; Theodora E Markatseli; Maria Matthaiou; Paraskevi Kosta; Paraskevi V Voulgari; Alexandros A Drosos

Tuberculous pyomyositis in a rheumatoid arthritis patient treated with anakinra

Clin Exp Rheumatol. 2015 Sep-Oct;33(5):734-6. Epub 2015 May 1.

Authors

Michael P Migkos¹, George A Somarakis¹, Theodora E Markatseli¹, Maria Matthaiou², Paraskevi Kosta³, Paraskevi V Voulgari¹, Alexandros A Drosos¹

Affiliations

¹ Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
² Pulmonary Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
³ Department of Clinical Imaging and Radiology, Medical School, University of Ioannina, Ioannina, Greece.

PMID: 25936426

Abstract

Musculoskeletal tuberculosis (TB) occurs in only 3% of patients with TB while tuberculous pyomyositis is rare. It usually affects immunocompromised or patients with underlying comorbidities. We present a case of tuberculous pyomyositis in a 85-year-old Caucasian patient with rheumatoid arthritis (RA) treated with steroids and anakinra. The patient presented with fever as well as redness, swelling and induration on the lateral side of the hip and thigh. Under ultrasound guidance fluid collection of the thigh was aspirated. Polymerase chain reaction (PCR) and cultures of the fluid were positive for Mycobacterium TB. The patient underwent bronchoscopy. PCR and cultures from the bronchoalveolar lavage were also positive for Mycobacterium TB. The patient was treated with anti TB treatment with amelioration of the inflammation in the hip and thigh. This is the first reported case of tuberculous pyomyositis in a RA patient treated with anakinra.

Publication types

Case Reports

MeSH terms

Aged, 80 and over
Antirheumatic Agents / adverse effects*
Antitubercular Agents / therapeutic use
Arthritis, Rheumatoid / diagnosis
Arthritis, Rheumatoid / drug therapy*
Arthritis, Rheumatoid / immunology
Humans
Immunocompromised Host
Interleukin 1 Receptor Antagonist Protein / adverse effects*
Magnetic Resonance Imaging
Male
Opportunistic Infections / chemically induced*
Opportunistic Infections / diagnosis
Opportunistic Infections / drug therapy
Opportunistic Infections / immunology
Opportunistic Infections / microbiology
Pyomyositis / chemically induced*
Pyomyositis / diagnosis
Pyomyositis / drug therapy
Pyomyositis / immunology
Pyomyositis / microbiology
Tomography, X-Ray Computed
Treatment Outcome
Tuberculosis / chemically induced*
Tuberculosis / diagnosis
Tuberculosis / drug therapy
Tuberculosis / immunology
Tuberculosis / microbiology

Substances

Antirheumatic Agents
Antitubercular Agents
Interleukin 1 Receptor Antagonist Protein