J Rheum Dis.  2022 Oct;29(4):243-253. 10.4078/jrd.22.0014.

Isolated Tuberculous Myositis: A Systematic Review and Multicenter Cases

• Kim JH
• Lee JS
• Choi BY
• Cheon YH
• Yoo SJ
• Ju JH
• Shin K
• Kim ES
• Baek HJ
• Park W
• Song YW
• Hong WH
• Lee YJ

• KMID: 2533625
• DOI: http://doi.org/10.4078/jrd.22.0014

Abstract

Objective
To investigate the clinical features and associated underlying conditions of isolated tuberculous myositis (ITBM), a rare extrapulmonary tuberculosis (TB).
Methods
A systematic literature search and a multicenter survey were performed using a triangulation strategy. Data from the identified ITBM cases were extracted and analyzed to determine the underlying conditions, clinical presentations, treatments, and outcomes.
Results
Based on the systematic review, we identified 58 ITBM, including 9 pediatric, cases in the literature published from 1981 to 2021: 25 (43.1%) immunocompromised and 33 (56.9%) non-immunocompromised patients. Immunocompromised cases had a significant shorter symptom duration (median 30.0 vs. 75.0 days) and a higher prevalence of multilocular involvement (20.8% vs. 0%). Among 24 immunocompromised adult patients, dermatomyositis/polymyositis (DM/PM; n=10, 41.7%) were the most common underlying diseases in adults with ITBM identified in the systematic review. Over the past 20 years, 11 Korean adults with ITBM were identified in the multicenter survey. Of 7 immunocompromised cases, two (28.6%) were DM/PM patients. TB death rate of immunocompromised patients was 0.0% and 5/23 (21.7%) in the pediatric and adult ITBM cases identified in the systematic review, respectively, and 3/7 (42.9%) in survey-identified ITBM cases.
Conclusion
ITBM has a unique clinical presentation including fever, tenderness, local swelling, overlying erythema, abscess formation and was associated with a grave outcome, especially in immunocompromised hosts. DM/PM was a highly prevalent underlying disease in both systematic review-identified and survey-identified immunocompromised ITBM patients.

Keyword

Mycobacterium tuberculosis; Infectious myositis; Dermatomyositis; Polymyositis

Figure

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  Fig. 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of study selection.

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  Fig. 2 The prevalence of underlying immunocompromised conditions in both systematic review-identified ITBM (A) and survey-identified ITBM (B) cases. ITBM: isolated tuberculous myositis.

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  Fig. 3 Clinical features of isolated tuberculous myositis (ITBM). (A) The regional distribution of muscle involvement in both systematic review-identified ITBM and survey-identified ITBM cases. The percentage of involvement of each region was calculated from the systematic review-based data of the cases. Circles represent cases identified from the literature search and squares indicate cases identified from the multicenter survey. Hatched circles indicate systematic review-identified pediatric ITBM cases. (B) The prevalence of symptoms in both systematic review-identified ITBM (pediatric and adults) and survey-identified ITBM patients. The figures above the bars are the number of cases.

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