Disseminated Mycobacterium abscessUs Infection Following Septic Arthritis A Case Report and review of the literature Shoichi Fukui, MD, Noritaka Sekiya, MD, Yasunobu Takizawa, MD, PhD, Hiroshi Morioka, mD Hirofumi Kato, MD, Akio Aono, Kinuyo Chikamatsu, Satoshi Mitarai, MD, PhD, Satomi Kobayashi, MD, Satoshi Kamei, MD, and Keigo Setoguchi, MD, PhD Medicine Volume 94, Number 21, May 2015
Disseminated Mycobacterium abscessus Infection Following Septic Arthritis A Case Report and Review of the Literature Shoichi Fukui, MD, Noritaka Sekiya, MD, Yasunobu Takizawa, MD, PhD, Hiroshi Morioka, MD, Hirofumi Kato, MD, Akio Aono, Kinuyo Chikamatsu, Satoshi Mitarai, MD, PhD, Satomi Kobayashi, MD, Satoshi Kamei, MD, and Keigo Setoguchi, MD, PhD Medicine Volume 94, Number 21, May 2015
CASE PRESENTAT○N A 75-year-old Japanese woman Chief complain: swelling of the right elbow and the wrist joint for a month She had no history of orthopedic surgery, joint trauma, or intraarticular injections joints She had a 17-year history of dermatomyositis after being diagnosed at 58 years of age, along with interstitial lung disease(ILD), pulmonary hypertension, chronic kidney disease, and raynaud phenomenon She had pulmonary tuberculosis at the age of 33, resulting in old inflammatory changes and volume loss in the left lung Later, her dermatomyositis proved to be antisynthetase syndrome with antithreonyl-tRNA synthetase antibody
CASE PRESENTATION ´ A 75-year-old Japanese woman ´ Chief complain：swelling of the right elbow and the wrist joint for a month ´ She had no history of orthopedic surgery, joint trauma, or intraarticular injections in those joints. ´ She had a 17-year history of dermatomyositis after being diagnosed at 58 years of age, along with interstitial lung disease (ILD), pulmonary hypertension, chronic kidney disease, and Raynaud phenomenon. ´ She had pulmonary tuberculosis at the age of 33, resulting in old inflammatory changes and volume loss in the left lung. ´ Later, her dermatomyositis proved to be antisynthetase syndrome with antithreonyl-tRNA synthetase antibody
Uses of immunosuppressants The last time to receive dose Psl therapy and P (4 years ago) received high-dose corticosteroid Therapy at least 3(45-60mg PSL per day continued for 4 weeks and admission tapered, with or without P-MPSL Started to remain on corticosteroids with the 9.5mg PSL diagnosis of dermatomyositis 17 years ago per day Methotrexate was only temporarily used 10 years before this event; they rere never used after that time
Uses of immunosuppressants ´ Methotrexate was only temporarily used 10 years before this event; they were never used after that time. admission Started to remain on corticosteroids with the diagnosis of dermatomyositis 17 years ago The last time to receive highdose PSL therapy and P-MPSL (4 years ago) 9.5mg PSL per day received high-dose corticosteroid Therapy at least 3 (45–60mg PSL per day continued for 4 weeks and tapered, with or without P-MPSL)
Physical examination Afebrile Her right elbow, forearm, and wrist joint were swollen with tenderness Erythema and warmth were noted on her right arm. No skin eruptions or nodules were found The cardiopulmonary and abdominal findings were normal Other vital signs were within normal limits
Physical examination ´ Afebrile ´ Her right elbow, forearm, and wrist joint were swollen with tenderness. Erythema and warmth were noted on her right arm. No skin eruptions or nodules were found. ´ The cardiopulmonary and abdominal findings were normal. ´ Other vital signs were within normal limits
Laboratory examinations BC9000/mL(3300-7600/mL.N%77%L%20%,M%3%,andE%0%) CRP 2.6mg/dLT(<0.3mg/dL) Cr 1.2mg/dL(.5-0.8mg/dL GFR 34.0mL/min No other abnormalities were detected on laboratory testing
Laboratory examinations ´ WBC 9000/mL (3300–7600/mL, N% 77%, L% 20%, M% 3%, and E% 0%). ´ CRP 2.6mg/dL （ <0.3mg/dL) ´ Cr 1.2mg/dL（0.5–0.8mg/dL ´ GFR 34.0mL/min ´ No other abnormalities were detected on laboratory testing