Dermatomyositis masquerading musculoskeletal tuberculosis.
Dermatomyositis is a rare rheumatic disease which predominantly affects the muscles and skin requiring a protracted course of immunosuppressants which may predispose the patients to opportunistic infections. A 49-year-old lady was diagnosed to have dermatomyositis in August 2010 based on history, significantly raised creatine kinase level and muscle biopsy findings. She had recurrent admissions due to fever, myalgia and muscle weakness. She had spiking temperature despite high dose steroids, broad-spectrum antibiotics and antifungal agents. This prompted extensive investigation which leads us to the additional diagnosis of disseminated tuberculosis involving the lungs, muscles and bones. This case demonstrates the challenge in controlling the disease activity of dermatomyositis with immunosuppressants in the setting of disseminated tuberculosis.
Department of Medicine, National University of Malaysia, Malaysia. sakthis5@hotmail.com
Sakthiswary
S
Rajalingham
Mohd Shahrir Mohd
MS
Said
Syahrul Sazliyana
SS
Shaharir
Aini
A
AbAziz
Petrick
P
Periyasamy
Fauzi Md
FM
Anshar
D000995:Antitubercular Agents / Q000627:therapeutic use; D003882:Dermatomyositis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000382:microbiology; D014394:Tuberculosis, Osteoarticular / Q000150:complications / Q000175:diagnosis*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis*
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents