title: [A case of multiple bone and joint tuberculosis which had been misdiagnosed as the rheumatoid arthritis and treated with prednisolone for eleven months].
abstract: A 34-year-old man had a multiple arthralgia for about eleven months. The swelling of his right wrist and foot had appeared in the dorsal side, and he had been misdiagnosed as the rheumatoid arthritis. He was treated with prednisolone in the dosages of 2.5 mg per day for one month, and 10 mg per day for ten months. When he admitted to our hospital, the bone X-ray examinations of the wrist and foot revealed the marked atrophy and destruction of the carpal and tarsal bones. The aspiration fluid from the swelling around his wrist and foot was positive for acid-fast bacilli on smear and Mycobacterium tuberculosis was found on culture. He was treated with isoniazid, rifampicin, ethambutol and pyrazinamide, however, these medication was not adequately effective to his complications of tuberculous arthritis. Curettage, irrigation and synovectomy of his right carpal and tarsal bone were performed in order to control his bone and joint infection. He recovered from his arthritis and tenosynovitis after these operations. The clinical practitioners should not omit tuberculosis from the differential diagnosis of persistent osteoarthralgia.
authors.affiliation: Department of the Respiratory Medicine, International Medical Center of Japan, 1-21-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. etsuduki@imcj.hosp.go.jp
authors.forename: Etsu
authors.initials: E
authors.lastname: Tsuduki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawada
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takeda
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyoda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kudo
authors.forename: Koji
authors.initials: K
authors.lastname: Osuka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kuroki
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Morita
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis*
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone