Korean J Med.  2014 Jun;86(6):785-790.

A Case of Musculoskeletal Tuberculosis Mimicking Adult-Onset Still's Disease

• Cho JK
• Kim MS
• Shin JH
• Jeong YS
• Kim JW
• Choi JP
• Choi BY

Abstract

A 46-year-old man was admitted to our hospital because of a fever of unknown origin. The patient had a skin rash, arthralgia, and hepatosplenomegaly. Laboratory tests showed leukemoid leukocytosis, a high serum ferritin level (31,200 ng/mL), and abnormal liver function tests. He was initially diagnosed with adult-onset Still's disease (AOSD). However, imaging studies incidentally detected a cold abscess involving the 11th thoracic vertebra. A biopsy of the abscess revealed histologically granulomatous caseous necrosis, positive for M. tuberculosis by polymerase chain reaction. We present a patient with musculoskeletal tuberculosis (TB) that clinically mimicked AOSD. In TB-endemic countries, extrapulmonary TB should be included in the differential diagnosis of AOSD.

Keyword

Fever of unknown origin; Mycobacterium tuberculosis; Osteoarticular; Still's disease; Adult-onset

MeSH Terms

Abscess
Arthralgia
Biopsy
Diagnosis, Differential
Exanthema
Ferritins
Fever of Unknown Origin
Humans
Leukocytosis
Liver Function Tests
Middle Aged
Mycobacterium tuberculosis
Necrosis
Polymerase Chain Reaction
Spine
Still's Disease, Adult-Onset*
Tuberculosis*
Ferritins