J Rheum Dis  
Isolated Tuberculous Myositis: A Systematic Review and Multicenter Cases
Ji Hyoun Kim, M.D.1,*, Jeong Seok Lee, M.D., Ph.D.2,*, Byoong Yong Choi, M.D.3, Yun-Hong Cheon, M.D.4, Su-Jin Yoo, M.D., Ph.D.5, Ji Hyeon Ju, M.D., Ph.D.6, Kichul Shin, M.D., Ph.D.7, Eu Suk Kim, M.D., Ph.D.8, Han Joo Baek, M.D., Ph.D.9, Won Park, M.D., Ph.D.10, Yeong Wook Song, M.D., Ph.D.2,11, Woi-Hyun Hong, Ph.D.12, Yun Jong Lee, M.D., Ph.D.13,14
1Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, 2Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, 3Division of Rheumatology, Department of Internal Medicine, Seoul Medical Center, Seoul, 4Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, 5Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 6Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 7Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, 8Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 9Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, 10Medicine/Rheumatology, School of Medicine, Inha University, Incheon, 11Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 12College of Medicine and Medical Research Information Center (MedRIC), Chungbuk National University, Cheongju, 13Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 14Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
Correspondence to: Yun Jong Lee, http://orcid.org/0000-0001-7615-8611
Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. E-mail: yn35@snu.ac.kr
Woi-Hyun Hong, http://orcid.org/0000-0002-1212-4444
College of Medicine and Medical Research Information Center (MedRIC), Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju 28644, Korea. E-mail: hong.medric@gamil.com
*These authors contributed equally to this work and share co-first authorship.
Received: March 22, 2022; Revised: June 7, 2022; Accepted: June 28, 2022; Published online: July 20, 2022.
© Korean College of Rheumatology.

This is a open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: To investigate the clinical features and associated underlying conditions of isolated tuberculous myositis (ITBM), a rare extrapulmonary tuberculosis (TB).
Methods: A systematic literature search and a multicenter survey were performed using a triangulation strategy. Data from the identified ITBM cases were extracted and analyzed to determine the underlying conditions, clinical presentations, treatments, and outcomes.
Results: Based on the systematic review, we identified 58 ITBM, including 9 pediatric, cases in the literature published from 1981 to 2021: 25 (43.1%) immunocompromised and 33 (56.9%) non-immunocompromised patients. Immunocompromised cases had a significant shorter symptom duration (median 30.0 vs. 75.0 days) and a higher prevalence of multilocular involvement (20.8% vs. 0%). Among 24 immunocompromised adult patients, dermatomyositis/polymyositis (DM/PM; n=10, 41.7%) were the most common underlying diseases in adults with ITBM identified in the systematic review. Over the past 20 years, 11 Korean adults with ITBM were identified in the multicenter survey. Of 7 immunocompromised cases, two (28.6%) were DM/PM patients. TB death rate of immunocompromised patients was 0.0% and 5/23 (21.7%) in the pediatric and adult ITBM cases identified in the systematic review, respectively, and 3/7 (42.9%) in survey-identified ITBM cases.
Conclusion: ITBM has a unique clinical presentation including fever, tenderness, local swelling, overlying erythema, abscess formation and was associated with a grave outcome, especially in immunocompromised hosts. DM/PM was a highly prevalent underlying disease in both systematic review-identified and survey-identified immunocompromised ITBM patients.
Keywords: Mycobacterium tuberculosis, Infectious myositis, Dermatomyositis, Polymyositis


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