Central diabetes insipidus induced by tuberculosis in a rheumatoid arthritis patient.
Tuberculosis, a polymorphic disease, is a diagnostic challenge, particularly when arises concomitantly to an autoimmune disease such as rheumatoid arthritis (RA). Herein, the authors describe a 33-year-old woman with nodular RA who was being treated with methotrexate, sulfasalazine and corticosteroids and presented with subcutaneous nodules simultaneously with aseptic meningitis. Mycobacterium tuberculosis was identified in cultures from a biopsy of an axillary nodule. The patient also developed polyuria and polydipsia with normal glycemia; antidiuretic hormone (ADH) treatment before and after a 3% saline infusion test was performed and diabetes insipidus was diagnosed. An encephalic MRI showed sellar and suprasellar masses, suggesting central diabetes insipidus (CDI). The patient received standard tuberculosis (TB) treatment for 6 months and also DDAVP (desmopressin acetate) during this period. Control of CDI was observed. A pre-surgical magnetic resonance imaging (MRI) showed no pituitary mass. It is known that intrasellar tuberculoma occurs in only 1% of TB patients. TB should be considered in the differential diagnosis of CDI, especially in immunosupressed patients and in countries where this infection is a serious public health problem.
Domiciano
Diogo Souza
DS
Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brazil.
de Carvalho
Jozélio Freire
JF
Macedo
André Régis
AR
Laurindo
Ieda Maria Magalhães
IM
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000382:microbiology*; D020790:Diabetes Insipidus, Neurogenic / Q000150:complications*; D005260:Female; D006801:Humans; D010900:Pituitary Diseases / Q000150:complications* / Q000382:microbiology*; D014383:Tuberculosis, Endocrine / Q000150:complications*