A Challenging Case of Polyarticular Juvenile Idiopathic Arthritis Mimicking Extrapulmonary Tuberculosis: Focus on Eyelid and Skin Manifestations
Author: Andi Pratiwi
Base Hospital / Institution: Wahidin Sudirohusodo Hospital, Makassar, Indonesia
ePoster presentation
Abstract ID: 25-426
Purpose
To report a challenging case of polyarticular juvenile idiopathic arthritis (JIA) initially misdiagnosed as extrapulmonary tuberculosis, with a focus on eyelid and cutaneous manifestations and the investigative approach leading to an accurate diagnosis and targeted management.
Methods
Case report
Results
A 12-year-old boy presented with incomplete eyelid closure persisting for three years. Ophthalmic evaluation revealed cicatricial ectropion of the right upper and lower eyelids. Visual acuity was preserved with no anterior or posterior segment abnormalities. Granulomatous lesions were present on the superolateral to inferior right eyelid, right forearm, and scapular region. He had been treated for lymphadenitis tuberculosis diagnosed in 2021 based on axillary lymph node biopsy, followed by anti-TB therapy until 2022 and extended treatment with rifampicin and isoniazid until April 2025 due to suspected abdominal TB. Comprehensive evaluation showed negative chest X-ray, acid-resistant Mycobacterium staining for sputum and skin tests, rapid molecular TB test, and HIV screening. Serological work-up revealed a markedly elevated rheumatoid factor (512 IU/mL). Extremity X-rays showed an old fracture and suspected osteomyelitis in multiple joints. The diagnosis of polyarticular JIA with cicatricial ectropion was established.The patient underwent eyelid reconstruction using postauricular skin graft. Histopathology of eyelid and skin lesions confirmed polyangiitis with a suppurative inflammatory reaction. During surgery, intralesional triamcinolone acetonide (10%) was administered. Anti-TB drugs were discontinued. Methotrexate (10 mg weekly) and oral prednisone (5 mg daily) was initiated, along with NSAIDs, zinc, and ranitidine. One month later, substantial clinical improvement was noted across all lesions.
Conclusion
Polyarticular JIA can closely mimic extrapulmonary tuberculosis, especially in cases with systemic and ocular involvement. Thorough systemic evaluation and clinician awareness are critical for timely diagnosis and effective management.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Bahrul | Fikri | Wahidin Sudirohusodo Hospital, Makassar, Indonesia |
| Rahmawati | Rahimi | Wahidin Sudirohusodo Hospital, Makassar, Indonesia |
| Nadirah | Rasyid Ridha | Wahidin Sudirohusodo Hospital, Makassar, Indonesia |
