The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Peripheral Bone Tuberculosis Mimicking Rheumatoid Arthritis

류마티스관절염 양상으로 발현된 말초 골결핵 1예

  • Kwak, Joo-Hee (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Lee, Joo-Hyun (Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University Collee of Medicine) ;
  • Kim, Sang-Heon (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Joo, Kyung-Bin (Department of Radiology, Hanyang University College of Medicine) ;
  • Jun, Jae-Bum (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Sung, Yoon-Kyoung (Department of Internal Medicine, Hanyang University College of Medicine)
  • 곽주희 (한양대학교 의과대학 내과학교실) ;
  • 이주현 (인제대학교 일산백병원 내과) ;
  • 김상헌 (한양대학교 의과대학 내과학교실) ;
  • 주경빈 (한양대학교 의과대학 영상의학교실) ;
  • 전재범 (한양대학교 의과대학 내과학교실) ;
  • 성윤경 (한양대학교 의과대학 내과학교실)
  • Received : 2013.09.20
  • Accepted : 2013.12.03
  • Published : 2014.09.01
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Abstract

A 30 year-old female visited our out-patient clinic with painful joint swelling in both hands and feet. Because she had tested positive for rheumatoid factor, and her inflammatory markers were elevated, the case was initially classified as rheumatoid arthritis (RA), according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. However, radiographic examinations, including simple radiography and MRI, revealed that her peripheral bone lesions were compatible with bone tuberculosis. The patient also exhibited pulmonary tuberculosis (TB) on chest X-ray and CT examinations. She was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EMB), and pyrazinamide (PZA), and exhibited a good response to these medications. The patient was diagnosed as having bone TB, and her peripheral bone lesions were resolved using anti-TB treatment. This was an uncommon case of bone TB mimicking RA.

우리는 다발성 관절통으로 내원한 환자에 대해 초기에 ACR/EULAR 분류 기준에 따라서 류마티스관절염으로 분류하였다. 그러나 추가적인 방사선 및 검사실 검사상 매우 드문 다발성 골결핵으로 진단하여 항결핵 치료로 좋은 효과를 보았다. 새로 제정된 2010년 ACR/EULAR 분류 기준은 류마티스관절염을 조기에 진단하는 데에 있어서 유용할 수 있으나 말초 관절염 환자를 진찰하는 데 있어서는 여전히 전신상태에 대한 자세한 병력 청취, 검사실 검사, 그리고 방사선학적 검사가 중요함을 알 수 있었다.

Keywords

References

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