J Rheum Dis.  2016 Feb;23(1):66-70. 10.4078/jrd.2016.23.1.66.

Nontuberculous Mycobacterium Arthritis and Spondylitis in a Patient with Lupus

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. bettyboomboo@hanmail.net
  • 2Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 3Division of Infection Disease, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 4Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Abstract

Approximately 90% of nontuberculous mycobacterium (NTM) infections involve the pulmonary system; NTM infections involving areas of the musculoskeletal system such as the joints or spine are uncommon. This report describes a case of refractory knee swelling in a patient with systemic lupus erythematosus (SLE). Indolent arthritis of the knee eventually progressed to spondylitis and a paraspinal abscess requiring surgical incision and drainage. The cause of the infectious arthritis and spondylitis was diagnosed as NTM infection, specifically Mycobacterium kansasii. This case emphasizes the importance of a high index of clinical suspicion for mycobacterial infection, as well as repeated attempts to isolate the organism, in patients with SLE who present with atypical chronic arthritis.

Keyword

Nontuberculous mycobacteria; Systemic lupus erythematosus

MeSH Terms

Abscess
Arthritis*
Arthritis, Infectious
Drainage
Humans
Joints
Knee
Lupus Erythematosus, Systemic
Musculoskeletal System
Mycobacterium kansasii
Nontuberculous Mycobacteria*
Spine
Spondylitis*

Figure

  • Figure 1. A knee radiograph shows bone erosions of the lateral femoral condyle and tibial plateau (arrows).

  • Figure 2. Gadolinium-enhanced coronal fat-suppressed T1-weigh-ted magnetic resonance images show a peripherally enhancing fluid collection in the suprapatellar pouch (arrows) and lateral gastrocnemial bursa (asterisk). Note the intense enhancement of the synovium of the knee joint and bone erosions of the lateral femoral condyle and tibial plateau (arrowheads).

  • Figure 3. (A) A gadolinium-en-hanced sagittal fat-suppressed T1-weighted magnetic resonance (MR) image shows heterogeneous enhancement of the L4 and L5 vertebral bodies, suggesting spondylitis (arrows). (B) A gadolinium-enhanced axial fat-suppressed T1-weighted MR image shows peripheral enhancement of a fluid collection in the right psoas muscle (arrow).


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