Tuberculous Fasciitis in Polymyositis: A Rare Case of Extrapulmonary Tuberculosis

Nagayama, Ikue; Nagatoya, Katsuyuki; Kurahara, Yu; Mega, A. C.; Morita, Masashi; Haga, Ryota; Yamanouchi, Yu; Yamaguchi, Yoshito; Oka, Tetsushi; Yamauchi, Atsushi

doi:10.2169/internalmedicine.55.5548

Cited by 5 publications

(3 citation statements)

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“…Although uncommon, this soft tissue infection may be encountered in immunocompromised patients, such as those with HIV infection. It has also been reported in patients receiving immunosuppressive treatment for rheumatic disease, including polymyositis and rheumatoid arthritis 1 2. To our knowledge, this is the first documented case of tuberculous fasciitis in a patient with SLE.…”

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confidence: 61%

Tuberculous fasciitis in a patient with systemic lupus erythematosus

et al. 2019

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Section: Descriptionmentioning

confidence: 61%

Tuberculous fasciitis in a patient with systemic lupus erythematosus

et al. 2019

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“…Interestingly Nagayama et al have previously described a case of Tuberculous myo-fasciitis in a patient with DM. 38 Subsequently, upon review of the eight instances of such Tubercular involvement in literature, three were found to have IIM. 38 It seems plausible that an inflamed muscle may act as a nidus for infection.…”

Section: Discussionmentioning

confidence: 99%

“… 38 Subsequently, upon review of the eight instances of such Tubercular involvement in literature, three were found to have IIM. 38 It seems plausible that an inflamed muscle may act as a nidus for infection.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Active Tuberculosis in Adults and Children with Idiopathic Inflammatory Myositis as Compared with Systemic Lupus Erythematosus in a Tuberculosis Endemic Country: Retrospective Data Review from a Tertiary Care Centre in India

Gupta

Aggarwal

Naveen

et al. 2021

MJR

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Aim: Infections are the leading cause of morbidity and mortality in idiopathic inflammatory myositis (IIM) with India being endemic for Tuberculosis (TB). We compared and contrasted the prevalence, clinical profile and outcomes of active TB in IIM with systemic lupus erythematosus (SLE). Methods: Medical records were reviewed for adults and children with IIM (Bohan and Peter criteria) and SLE (ACR criteria) at a tertiary care hospital in India from January 2015 to October 2017. Follow-up was recorded until February 2020 for all those who had developed active TB. Results: Of 167 (132 adults and 35 juvenile) IIM and 280 (131 adults and 149 juvenile) SLE, active TB occurred in 24 (14.4%) IIM (22 (16.7% of 132) adults; 2 (5.71% of 35) juvenile) and 18 (6.4%) SLE [(8 (6.1% of 131) adults; 10 (6.7% of 149) juvenile, p-value < 0.01]. Patients with IIM had higher odds of developing TB as compared with SLE [OR 2.24 (CI 1.5–5.5), p=0.007]. The risk of developing active TB was 68-fold and 30.4-fold higher in patients with IIM and SLE, respectively, as compared with the general population. Extrapulmonary forms were more common (14/24). Nearly half developed TB during active IIM, at a glucocorticoid dose of 0.25 (0–1.5) mg/kg/day. Over a follow-up duration of 27 months (8–184), all were cured of TB, though prolonged course of anti-tuberculous treatment was required in 25%, and five IIM relapsed during treatment. Conclusion: Patients with IIM have increased risk of active TB, with common extrapulmonary forms, slow response, and relapses during treatment.

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High burden of infections in Indian patients with Idiopathic Inflammatory Myopathy: validation of observations from the MyoCite dataset

et al. 2021

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Objective To determine the prevalence, profile and predictors of infections in an Indian cohort of IIM. Methods We reviewed the records of a retrospective cohort of IIM enrolled from consecutive patients following up in the clinic as the observation cohort (OC). A newly diagnosed inception cohort of IIM were followed prospectively as the validation cohort (VC) to confirm observations and compare with the OC. Results Among 68 patients in the OC (age 33.4 years, F: M 4.2:1), 37(54.4%) experienced 54 infections, of which 21(38.8%) were major and recurrent infections in 11 patients(16.17%) over 3.08 years. Tuberculosis was the most common infection(12, 22.2%), with predominance of extra-pulmonary forms. Serum protein(OR 0.44), platelets(0.44) at disease onset and daily steroid dose(1.04) predicted major infections on multivariate analysis. A higher daily dose of steroids at first infection correlated with number of recurrent infections. Infection free one-year survival was 73.8%. Of 70 patients in VC (35.7 years, F: M 3.7:1), three had myositis attributed to an infection. Similar proportion of total(22, 33.3%), major(10, 45.4%) and recurrent(4,18%) infections were recorded. Most common infection was community acquired pneumonia, followed by Tuberculosis with serum albumin(OR 0.25) at disease onset being the only predictor. One-year infection free survival was 64.7%. Those who had a major infection had increased mortality at 1 year with survival of 60% compared with 89.09% in those without. In both cohorts, a daily prednisone dose >6.25 mg predisposed to major infections. Conclusion Major and recurrent infections are common in Indian IIM patients and confer higher risk for future infections and lower survival. Respiratory and atypical bacterial infections such as Tuberculosis occur throughout the disease course.

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Tuberculous Fasciitis in Polymyositis: A Rare Case of Extrapulmonary Tuberculosis

Cited by 5 publications

References 5 publications

Tuberculous fasciitis in a patient with systemic lupus erythematosus

Tuberculous fasciitis in a patient with systemic lupus erythematosus

High Prevalence of Active Tuberculosis in Adults and Children with Idiopathic Inflammatory Myositis as Compared with Systemic Lupus Erythematosus in a Tuberculosis Endemic Country: Retrospective Data Review from a Tertiary Care Centre in India

High burden of infections in Indian patients with Idiopathic Inflammatory Myopathy: validation of observations from the MyoCite dataset

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