Co-occurrence of Rheumatoid Arthritis and Pulmonary Tuberculosis: A Diagnostic and Therapeutic Challenge

Abstract

The co-occurrence of rheumatoid arthritis (RA) and pulmonary tuberculosis (TB) poses diagnostic and therapeutic challenges in patients receiving immunosuppressive therapy. In this case report, we present a 45-year-old male with a history of multiple joint pain for 8 years, suggestive of RA. The patient had been taking NSAIDs for 3 years, but his symptoms worsened in the last month. Laboratory investigations revealed elevated levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (antiCCP) antibodies, supporting the diagnosis of RA. He was initiated on methotrexate, hydroxychloroquine, and folate. However, he developed respiratory symptoms, including a productive cough and fever. Physical examination findings indicated respiratory abnormalities and radiographic imaging showed bilateral opacities. Further assessment with HRCT thorax revealed fibrocavitary lung lesions and mediastinal lymphadenopathy. Microbiological confirmation through CBNAAT testing demonstrated the presence of Mycobacterium tuberculosis, leading to the diagnosis of pulmonary Tuberculosis. The patient was promptly started on anti-tubercular treatment. This case highlights the challenges faced in managing patients with both RA and TB under immunosuppressive therapy. A multidisciplinary approach involving rheumatologists and infectious disease specialists is crucial for optimal management and favourable outcomes.