TY - JOUR T1 - Recurrent lung shadowing in adult juvenile idiopathic arthritis JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 742 LP - 744 DO - 10.1136/ard.58.12.742 VL - 58 IS - 12 AU - Tsui Lian AU - John Brittenden AU - Stanley Pearson AU - Paul Emery Y1 - 1999/12/01 UR - http://ard.bmj.com/content/58/12/742.abstract N2 - A 25 year old Asian woman with a 11 year history of juvenile idiopathic arthritis (polyarthritis, rheumatoid factor positive) was referred from a peripheral hospital with poor disease control despite multiple disease modifying anti-rheumatic drugs (DMARDS). She was not a cigarette smoker and had been taking azathioprine 125 mg daily and prednisolone 5 mg daily for the past 10 months. Her past medical history included pulmonary tuberculosis diagnosed 14 months ago for which she had completed six months of antituberculous treatment. Details of her previous respiratory management including radiographs were not available. Physical examination revealed generalised synovitis with normal respiratory findings. She was treated with intra-articular corticosteroid injections into multiple joints and sulfasalazine was added to her above medications. Sulfasalazine was increased to a dose of 2 g daily over a four week period.One month later, she re-presented with about two weeks history of dry cough and dyspnoea. Physical examination revealed that she was apyrexial with normal respiratory findings and persistent synovitis. Based on her chest radiograph (fig 1A) showing patchy consolidation in the right lung, more prominently in the right mid and upper zones, and left lower zone, the presumed diagnosis was pneumonia, possibly with an atypical microorganism and she was treated with a course of ampicillin and erythromycin while investigations were performed. The main differential diagnosis was the recurrence of pulmonary tuberculosis. Laboratory investigations were largely unchanged from the previous month, with a normochromic … ER -