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Granulomatous synovialitis with erosions in the shoulder joint: a rare case of polyarthritis caused by Mycobacterium kansasii
  1. K Loddenkemper1,
  2. C Enzweiler2,
  3. C Loddenkemper3,
  4. M Backhaus1,
  5. G-R Burmester1,
  6. F Buttgereit1
  1. 1Department of Rheumatology and Clinical Immunology, University Medicine Berlin Charité University Hospital, Schumannstrasse 20–21, 10117 Berlin, Germany
  2. 2Department of Radiology, University Medicine Berlin, University Hospital Charité, Schumannstrasse 20–21, 10117 Berlin, Germany
  3. 3Institute of Pathology, University Hospital Charité, University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
  1. Correspondence to:
    Dr K Loddenkemper

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We present the rare case of a 60 year old man with Mycobacterium kansasii infection who complained of severe joint pain and swelling, predominantly of the right shoulder. Non-steroidal anti-inflammatory drugs (NSAIDs) led to pain relief. The swelling around the right shoulder was unsuccessfully treated by aspiration followed by surgery.


As a steam engine driver the patient was exposed to asbestos and inorganic dusts (coal, mineral/silicate). The rheumatological examination disclosed a mobile, firm, elastic swelling over the dorsal aspect of the left elbow, tenderness and mild swelling of both wrists, the metacarpophalangeal (MCP) joints, the third fingers of both hands, and the MCP joints of both thumbs. Joint effusion was palpated around the right shoulder and mobility was limited owing to pain. Inflammatory measures were raised and angiotensin converting enzyme was within normal range. No evidence of acid fast rods …

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