[A case of miliary tuberculosis after adrenocorticosteroid medication for tuberculosis of the wrist].

This report is a case study of miliary tuberculosis that was induced when adrenocorticosteroid treatment for tuberculosis of the wrist was given because of a mistaken diagnosis of rheumatoid arthritis. An 85-year-old man was admitted to a hospital with a fever and chest pains. Since an examination of the chest X-ray revealed fine nodules throughout both lungs and a sputum smear tested positive for acid-fast bacilli, he was transferred to our hospital. The patient had a three-year history of pain in his left wrist joint. He had swelling on the dorsal aspect of his left wrist for 1 1/2 years, and had been diagnosed as having rheumatoid arthritis. Prednisolone had been administered in dosages of 5 mg per day for two months and 5 mg every other day for four months prior to admission. Upon admission to the hospital, an X-ray examination of the wrist revealed marked destruction of the left carpal bones. Smears of fluid aspirated from the swelling showed acid-fast bacilli, and cultures grew M. tuberculosis. He was treated with INH, RFP and SM, however, he had complications of tuberculous spondylitis and renal tuberculosis, and died nine months after admission.