A 44-year-old man had been admitted for high
fever and leg
edema on November 1998. By the laboratory data, electromyography, and muscle biopsy, he was diagnosed as having
polymyositis.
Steroid (
prednisolone 60 mg/day) and
immunosuppressant (
methotrexate 7.5 mg/week)
therapy was administered and the symptoms were improved, so he had been followed up in out-patient clinic. After half a year, high
fever and leg
edema relapsed and
erythema on the bilateral forearms appeared, so he was admitted again on January 2000. The symptoms, skin involvement and laboratory data suggested the disease of
dermatomyositis.
Steroid pulse
therapy was administered again. But the symptoms were not improved. Skin biopsy was performed but it showed only inflammatory changes. Several
antibiotics and cyclospolyn A were undertaken but they were not effective. On February 12th he passed away because of
respiratory failure. The autopsy was undertaken and it revealed
tuberculosis in the skin, subcutaneous tissues and muscles, however,
pulmonary tuberculosis was not found. The patient with
collagen disease is considered to be "compromised host", especially during
corticosteroid therapy. We must keep in mind potential incidence of
tuberculosis and do careful clinical observation for early diagnosis and be prepared for antituberculous
chemotherapy.
Chemoprophylaxis for
tuberculosis seems to be desirable for higher risk patients.