ABSTRACT
A 78-year-old woman with rheumatoid arthritis, who was started on baricitinib five or six months earlier, was referred to our hospital due to a subcutaneous abscess in her right axilla. Contrast-enhanced chest, abdomen, and pelvis computed tomography showed subcutaneous abscesses in her right axilla and lymphadenopathy with calcification. Cultures from the subcutaneous abscess and skin biopsy specimens were positive for Mycobacterium tuberculosis. These findings led to the diagnosis of scrofuloderma associated with tuberculous lymphadenitis. She was started on an antitubercular regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol as the initial phase treatment (first 2 months), followed by isoniazid and rifampicin for 4 months (total 6 months). After 6 months of antitubercular treatment, the abscesses and lymphadenitis disappeared. Although cases of tuberculosis during JAK inhibitor treatment are rare, they are serious adverse events that require caution.
Subject(s)
Antitubercular Agents , Arthritis, Rheumatoid , Janus Kinase Inhibitors , Pyrazoles , Sulfonamides , Tuberculosis, Lymph Node , Humans , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/complications , Female , Aged , Janus Kinase Inhibitors/adverse effects , Antitubercular Agents/adverse effects , Antitubercular Agents/administration & dosage , Sulfonamides/adverse effects , Sulfonamides/administration & dosage , Pyrazoles/adverse effects , Tuberculosis, Lymph Node/drug therapy , Tuberculosis, Lymph Node/diagnosis , Purines/adverse effects , Purines/administration & dosage , Azetidines/adverse effects , Azetidines/administration & dosage , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Cutaneous/drug therapy , Treatment Outcome , Mycobacterium tuberculosis/isolation & purification , Drug Therapy, Combination , Isoniazid/adverse effects , Isoniazid/administration & dosageABSTRACT
Zinc deficiency has long been known as acrodermatitis enteric dermatitis (congenital zinc deficiency). On the other hand, acquired zinc deficiency has attracted attention as a familiar disease in recent years. Epidemiological studies in Japan have shown that acquired zinc deficiency is more common than expected. It is also known that serum zinc levels fall markedly with age. In this report, several cases of acquired zinc deficiency that caused cheilitis are described. In all cases, the only symptom was cheilitis, the serum zinc level was low, and all cases were relieved by zinc supplementation. Zinc deficiency is associated with a range of pathological conditions, including mucocutaneous symptoms, delayed wound healing, dysgeusia, anemia, impaired immunity, and retarded growth development disorders. However, zinc deficiency may be overlooked even in cases of cheilitis alone. Especially in intractable cases, it is important to suspect zinc deficiency as one at the differential diagnoses.