Pulmonary tuberculosis in a patient with rheumatoid arthritis undergoig immunosuppressive treatment: case report

Ceratti, Sandro; Pereira, Talita Rombaldi; Velludo, Sílvio Fontana; Dalcim, Leonardo Pereira; Machado, Gladston Oliveira; Hasimoto, Hélio Kiyoshi

doi:10.1590/s0100-39842014000100019

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…The high‐resolution thoracic CT scan showed nodules in right lower and left upper lung fields. Results of biopsy were consistent with caseous granulomas found in pulmonary tuberculosis 17 …”

Section: Discussionsupporting

confidence: 77%

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A case report of extra‐articular manifestation of rheumatoid arthritis: Rheumatoid nodules in lungs

Bektyrganova,

Kozhakhmet,

Kim

et al. 2023

Int J of Rheum Dis

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Rheumatoid arthritis is a systemic inflammatory disorder primarily affecting joints but not limited to the joints alone. Extra‐articular manifestations involve skin, ocular, gastrointestinal, pulmonary, cardiac, renal, neurological, and hematological systems. Among them, skin manifestations (20%) are most common, presenting as nodules on the extensor surfaces of the upper and lower extremities. In rare cases these nodules can also be detected within the heart and lungs. Interestingly, rheumatoid nodules are often seen in patients on leflunomide, methotrexate, or tumor necrosis factor‐alpha antagonists. Nevertheless, definitive diagnosis requires a histopathological analysis. In this case report, we presented a 49‐year‐old male patient with a relatively short period of disease activity leading to rheumatoid nodules in the lungs. Considering the ongoing COVID‐19 pandemic and that tuberculosis was still endemic in Kazakhstan, achieving the definite diagnosis was challenging. Initial imaging study revealed bilateral polysegmental pneumonia. The tests for COVID‐19 and pulmonary tuberculosis were negative. A follow‐up chest computed tomography scan had signs of disseminated lung lesions of unknown origin. Lung biopsy showed a morphological picture of productive granulomas characteristic for tuberculosis. However, at the second look, typical scarring granulomas typically seen in rheumatoid nodules were observed.

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Section: Discussionsupporting

confidence: 77%

“…Results of biopsy were consistent with caseous granulomas found in pulmonary tuberculosis. 17 In our patient, RA began with small joint arthralgia without any EAMs. Pulmonary symptoms occurred 3 years later and these symptoms overlap with COVID-19 infection.…”

Section: Differential Diagnosis For Pulmonary Nodules Includes Pulmonarymentioning

confidence: 50%

A case report of extra‐articular manifestation of rheumatoid arthritis: Rheumatoid nodules in lungs

Bektyrganova,

Kozhakhmet,

Kim

et al. 2023

Int J of Rheum Dis

View full text Add to dashboard Cite

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“…The imaging evaluation of the chest has been the subject of a series of recent publications in the Brazilian radiological literature ( 8 - 18 ) . With respect to PAM, studies analyzing large samples have not detected any gender predominance ( 2 ) .…”

Section: Discussionmentioning

confidence: 99%

Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis?

et al. 2015

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ObjectiveThe present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma.Materials and MethodsThirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed.ResultsGround-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%).ConclusionAs regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.

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“…The assessment of the chest by imaging methods has been object of a series of recent publications in the Brazilian radiological literature ( 16 - 27 ) . Chest radiography is an excellent imaging method in the evaluation of pulmonary tuberculosis ( 4 ) .…”

Section: Discussionmentioning

confidence: 99%

Radiological findings of pulmonary tuberculosis in indigenous patients in Dourados, MS, Brazil

Lachi

Nakayama

2015

Radiol Bras

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ObjectiveTo describe the radiological findings of pulmonary tuberculosis in indigenous patients from the city of Dourados, MS, Brazil, according to age and sex.Materials and MethodsChest radiographic images of 81 patients with pulmonary tuberculosis, acquired in the period from 2007 to 2010, were retrospectively analyzed by two radiologists in consensus for the presence or absence of changes. The findings in abnormal radiographs were classified according to the changes observed and they were correlated to age and sex. The data were submitted to statistical analysis.ResultsThe individuals’ ages ranged from 1 to 97 years (mean: 36 years). Heterogeneous consolidations, nodules, pleural involvement and cavities were the most frequent imaging findings. Most patients (55/81 or 67.9%) were male, and upper lung and right lung were the most affected regions. Fibrosis, heterogeneous consolidations and involvement of the left lung apex were significantly more frequent in males (p < 0.05). Presence of a single type of finding at radiography was most frequent in children (p < 0.05).ConclusionBased on the hypothesis that indigenous patients represent a population without genetically determined resistance to tuberculosis, the present study may enhance the knowledge about how the pulmonary form of this disease manifests in susceptible individuals.

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Pulmonary tuberculosis in a patient with rheumatoid arthritis undergoig immunosuppressive treatment: case report

Cited by 9 publications

References 7 publications

A case report of extra‐articular manifestation of rheumatoid arthritis: Rheumatoid nodules in lungs

A case report of extra‐articular manifestation of rheumatoid arthritis: Rheumatoid nodules in lungs

Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis?

Radiological findings of pulmonary tuberculosis in indigenous patients in Dourados, MS, Brazil

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