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    Tuberculosis the great masquerader.

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    Author
    Wang, Elizabeth Wenqian
    Okwesili, Christine N
    Doub, James B
    Date
    2022-06-18
    Journal
    IDCases
    Publisher
    Elsevier
    Type
    Article
    
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    See at
    https://doi.org/10.1016/j.idcr.2022.e01541
    Abstract
    With increased use of disease-modifying antirheumatic drugs, screening for latent tuberculosis infection is more important than ever. However, even with appropriate screening, reactivation of tuberculosis can occur in patients who have had significant epidemiological exposures. Herein, we present a case of a seventy-four-year-old woman with severe rheumatoid arthritis on long-term disease-modifying antirheumatic drugs who developed cryptic miliary tuberculosis. Histopathological findings from an abdominal lymph node biopsy showed caseating granulomas which were initially attributed to her rheumatoid arthritis given screening tests and sputum acid-fast cultures were negative for tuberculosis. It was not until tuberculosis spondylitis developed that the diagnosis was finally elucidated. This case highlights the need for clinicians to be vigilant about discussing historical epidemiological exposures to tuberculosis instead of relying solely on screening testing.
    Rights/Terms
    © 2022 The Authors.
    Keyword
    Disease-modifying agents
    Miliary tuberculosis
    Mycobacterium tuberculosis
    Rheumatoid arthritis
    Spondylitis
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/19299
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.idcr.2022.e01541
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