Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Infections
Abstract number: 26288
MILIARY TUBERCULOSIS AND NECROTIZING TUBERCULOUS FASCIITIS-AN
UNUSUAL COEXISTENCE IN A RHEUMATOID ARTHRITIS PATIENT
Sang-Wook LEE, Seung-Hoon BAEK, Shin-Kun KIM, Chang-Hyuk CHOI, Myung-
Rae CHO, Sang-Bong KO, Dong-Young SHIN
Daegu Catholic University Medical Center, Daegu (KOREA)
We report a case of a 65-year-old Korean female patient with rheumatoid arthritis,
who presented with extensive necrotizing fasciitis of the gluteus muscles, as an
unusual initial manifestation of miliary tuberculosis. The patient had previously been
treated with conventional disease modifying antirheumatic drugs and low dose
steroid for 7 years. However, she recently developed fever, warmth and painful
swelling in her right buttock area. Magnetic resonance imaging indicated necrotizing
fasciitis of the gluteus muscles and a fasciectomy specimen revealed a
Mycobacterium tuberculosis infection. Two weeks after a fasciectomy, miliary
tuberculosis of the lung was diagnosed by high resolution computed tomography.
With this case, a soft tissue infection caused by mycobacterium tuberculosis should
be included in a differential diagnosis of an immunocompromised host. Furthermore,
clinicians should be alert to rare presenting clinical features of miliary tuberculosis
that show a normal chest radiograph and no respiratory symptoms.
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