Korean Journal of Family Medicine

Hidden in plain sight: the diagnostic dilemma of tuberculous synovitis: a case report: Nadiah Ismail, Mohd Romzi Abd Rahman, Siti Aishah Ahmad Maulana; Korean J Fam Med 2026;47(1):89-92. Published online November 18, 2025; DOI: https://doi.org/10.4082/kjfm.25.0091

Abstract
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Tuberculous synovitis (TS) is an infrequent yet significant manifestation of tuberculosis (TB), particularly in regions where TB is endemic. The clinical presentation of TS is often nonspecific yet distinctive, and diagnosis is confirmed by histopathological examination. Anti-TB therapy is the cornerstone of treatment, although the necessity of surgical intervention remains debated. A case was reported of a 73-year-old female patient who complained of left wrist pain and swelling for the past 3 years. The left wrist was swollen from the metacarpophalangeal joints to the mid-forearm. Radiography on the left forearm revealed extensive, mixed predominant osteolytic and sclerotic bony lesions affecting all the carpal bones. These findings were associated with increased size of a hyperdense soft tissue swelling. Magnetic resonance imaging revealed rim-enhancing multiple encapsulated cystic fluid collections at the distal radioulnar and carpal regions. A biopsy of the left wrist was performed, revealing TS. The patient was subsequently started with anti-TB therapy.

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Assessing Pulmonary Tuberculosis Using Bandim Tuberculosis and Karnofsky Performance Scale Scores with Serum Adenosine Deaminase Levels: Krishna Sarkar, Bineeta Kashyap, Rajat hamb, S. V. Madhu; Korean J Fam Med 2023;44(4):234-239. Published online July 18, 2023; DOI: https://doi.org/10.4082/kjfm.22.0191

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Background
Elevated pulmonary serum adenosine deaminase (ADA) levels signify lung tissue damage and severe tuberculosis (TB). Serum ADA assays can be used as an additional criterion for assessing TB treatment response and as a prognostic marker in patients with pulmonary TB. The Bandim TB and Karnofsky Performance Scale (KPS) scores were developed based on available clinical data and investigations to allow physicians to evaluate disease treatment and response. This study examined the use of a clinical scoring system (Bandim TB and KPS scores) in the context of serum ADA activity.
Methods
Forty adults (aged >18 years) diagnosed with pulmonary TB by Ziehl-Neelsen staining for acid-fast bacilli and/or cartridge-based nucleic acid amplification test were recruited. Standardized questionnaires were used to record Bandim TB and KPS scores. Serum ADA levels were estimated using a commercial kit.
Results
The Bandim TB score was positively associated (ρ=0.74, P≤0.001) and the KPS score was negatively associated (ρ=-0.69, P≤0.001) with serum ADA levels.
Conclusion
Subjective and objective clinical scores of pulmonary TB were strongly correlated with serum ADA levels. Knowledge of clinical scores corresponding to serum ADA levels could help physicians understand stage and progression of the disease which may aid in early detection and better management, and reduce disease transmission in a TB-endemic country.

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A novel hematological score (HS) and its related nomogram model to predict nontuberculous mycobacterial pulmonary disease in patients with suspected multidrug-resistant pulmonary tuberculosis
Qi Yu, Shengling Hu, Fenfang Liu, Fengyun Gong
Annals of Medicine.2024;[Epub] CrossRef
Correlation Between MTB/RIF Gene Xpert Cycle Threshold Values and Clinical Radiological Severity of Pulmonary Tuberculosis
Rachmi Merrina, Budi Yanti, Yunita Arliny
Indonesian Journal of Tropical and Infectious Disease.2024; 12(2): 73. CrossRef

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Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults: Min Sung Kim, Chang-Jin Choi, Kyung Min Kwon, Kyung-Soo Kim, Whan-Seok Choi, Yoon Jee Oh; Korean J Fam Med 2019;40(2):93-99. Published online December 4, 2018; DOI: https://doi.org/10.4082/kjfm.17.0083

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Background
Vitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB.
Methods
The data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008–2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed.
Results
Evidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV1) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error=49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the nonPTB group.
Conclusion
FEV1 tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

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Post-pulmonary tuberculosis lung function: a systematic review and meta-analysis
Sharenja Ratnakumar, Sally E Hayward, Emma K Denneny, Lucy P Goldsmith, Rebecca Evans, William Checkley, Delia Goletti, Catherine W M Ong, Mateusz Gotowiec, Junkai Zhu, Jon S Friedland, Joanna C Porter
The Lancet Global Health.2025; 13(6): e1020. CrossRef
Post-tuberculosis lung impairment: systematic review and meta-analysis of spirometry data from 14 621 people
Olena Ivanova, Verena Sophia Hoffmann, Christoph Lange, Michael Hoelscher, Andrea Rachow
European Respiratory Review.2023; 32(168): 220221. CrossRef
Associating the blood vitamin A, C, D and E status with tuberculosis: a systematic review and meta-analysis of observational studies
Fei Xu, Baolan Ma, Dandan Wang, Jialin Lu, Ke Xiong, Jinyu Wang
Food & Function.2022; 13(9): 4825. CrossRef
Effectiveness of Maternal Vitamin D Supplementation in Preventing Respiratory Tract Infections in Children
Soo Young Kim
Korean Journal of Family Medicine.2022; 43(3): 155. CrossRef
Decreased lung function is associated with vitamin D deficiency in apparently health, middle aged Koreans: the Kangbuk Samsung Health Study
Jonghoo Lee, Hye Kyeong Park, Min-Jung Kwon, Soo-Youn Ham, Si-Young Lim, Jae-Uk Song
European Journal of Clinical Nutrition.2021; 75(3): 501. CrossRef

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Superior Vena Cava Syndrome Due to Mediastinal Tuberculous Lymphadenitis: Jin Ho Jang, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Hye Ju Yeo; Korean J Fam Med 2017;38(3):166-168. Published online May 23, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.3.166

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Superior vena cava (SVC) syndrome refers to a medical emergency resulting from compression of the SVC. It requires early diagnosis and treatment, and is usually caused by malignant tumors; rarely, mediastinal tuberculous lymphadenitis can cause SVC syndrome. Here, we present a case study of an immunocompetent 61-year-old woman who presented with acute onset SVC syndrome and was diagnosed with tuberculous lymphadenitis on thoracotomy; the symptoms resolved with anti-tuberculosis therapy. This unusual case highlights the importance of the differential diagnosis in patients presenting with acute onset SVC syndrome; a timely diagnosis and appropriate treatment lead to complete recovery.

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Diagnostic challenges in differentiating mediastinal tuberculosis from mediastinal tumors: A case report
Aida, Noni Novisari Soeroso, Herani Mutia Riandini
Respiratory Medicine Case Reports.2025; 53: 102152. CrossRef
A mediastinal lesion with superior vena cava obstruction: A diagnostic and therapeutic challenge
Sharada V. Kutty, Naren Chandra, Karan Madan, Ashu S. Bhalla, Priyanka Naranje, Anant Mohan, Vijay Hadda, Junaid Kazimi, Abhishek Jayant, Shraddhanjali Satpathy, Aruna Nambirajan, Pawan Tiwari, Saurabh Mittal
Lung India.2024; 41(5): 382. CrossRef
Facial Swelling Mimicking Anaphylaxis: A Case of Superior Vena Cava Syndrome in the Emergency Department
Mohamed Elamin Salama, Patrick Ukwade, Abdur Rafeh Khan, Hasan Qayyum
Cureus.2022;[Epub] CrossRef
Acute Hemodynamic Compromise Following Superior Vena Cava Stent Placement: a Case Report
Vaibhav Anand, Majid Maybody, Gregory W. Fischer, Anahita Dabo-Trubelja
SN Comprehensive Clinical Medicine.2020; 2(12): 2953. CrossRef

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The Clinical Characteristics and Predictors of Treatment Success of Pulmonary Tuberculosis in Homeless Persons at a Public Hospital in Busan: Dal-Joo Heo, Hong Gi Min, Hyun Ho Lee; Korean J Fam Med 2012;33(6):372-380. Published online November 27, 2012; DOI: https://doi.org/10.4082/kjfm.2012.33.6.372

Abstract
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Background

Homelessness is associated with an increased risk of exposure to Mycobacterium tuberculosis. Several factors, including alcoholism, malnutrition, lack of stable housing, combine to make tuberculosis more prevalent in the homeless. The aims of this study were to determine the factors associated with increasing success rate of tuberculosis treatment in the homeless.

Methods

A cross-sectional analysis of the clinical features in 142 pulmonary tuberculosis-positive homeless patients admitted to the Busan Medical Center from January 2001 to December 2010 was carried out. These results were compared with a successful treatment group and incomplete treatment group. We also evaluated the risk factors of treatment non-completion. Statistical analysis for the comparisons was performed using a χ² test, independent samples t-test, and multiple logistic regression.

Results

Comparison of clinical characteristics showed significant differences between the two groups in the type of residence (P < 0.001), diseases with risk factors (P = 0.003), and history of tuberculosis treatment (P = 0.009). Multiple regression analysis revealed the residence (odds ratio [OR], 4.77; 95% confidence interval [CI], 2.05 to 11.10; P < 0.001) and comorbidity with risk factor (OR, 2.72; 95% CI, 1.13 to 6.53; P = 0.025) to be independently associated with treatment success.

Conclusion

To improve the success rate of tuberculosis treatment in the homeless person, anti tuberculosis medication should be taken until the end of treatment and a management system for the homeless person is required. Further social and medical concerns for stable housing and management of comorbidity may lead to an improvement in the successful tuberculosis treatment of homeless person.

Citations

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Prevalence of pulmonary tuberculosis and its associated factors among people who ecprience homelessness living in selected towns in Wolaita zone, southern Ethiopia
Sisaynesh Kenu, Takele Teklu, Fithamlak Solomon Bisetegn, Getachew Alemu
Journal of Health, Population and Nutrition.2025;[Epub] CrossRef
Prevalence of Smear-Positive, Rifampicin-Resistant Mycobacterium tuberculosis and Related Factors Among Residents with Cough in Northern Ethiopian Refugee Health Facilities
Hailemariam Mezgebe, Teklay Gebrecherkos, Dawit Hagos, Saravanan Muthupandian
Infection and Drug Resistance.2024; Volume 17: 1135. CrossRef
Prevalence and Characteristics of Tuberculosis in the Korean Homeless Population Based on Nationwide Tuberculosis Screening
Heesang Han, Ji-Hee Lee, Sung Jun Chung, Beong Ki Kim, Yedham Kang, Hangseok Choi, Hee-Jin Kim, Seung Heon Lee
Tuberculosis and Respiratory Diseases.2024; 87(4): 514. CrossRef
Impact of Active Surveillance for Carbapenem-resistant Enterobacterales in a Homeless Patient Ward
Dong Hoon Shin, Jeong Eun Yoon, Inhyang Eom, Namhee Kim, Mi Seon Han, Sang Won Park, Eunyoung Lee
Korean Journal of Healthcare-Associated Infection Control and Prevention.2024; 29(2): 128. CrossRef
Inadequate housing and pulmonary tuberculosis: a systematic review
Ju-Yeun Lee, Namhee Kwon, Ga-yeon Goo, Sung-il Cho
BMC Public Health.2022;[Epub] CrossRef
Tuberculosis in the street population: a systematic review
Paula Hino, Thais Tiemi Yamamoto, Shyrlaine Honda Bastos, Aline Ale Beraldo, Tânia Maria Ribeiro Monteiro de Figueiredo, Maria Rita Bertolozzi
Revista da Escola de Enfermagem da USP.2021;[Epub] CrossRef
Smear positive pulmonary tuberculosis and associated factors among homeless individuals in Dessie and Debre Birhan towns, Northeast Ethiopia
Tsedale Semunigus, Belay Tessema, Setegn Eshetie, Feleke Moges
Annals of Clinical Microbiology and Antimicrobials.2016;[Epub] CrossRef

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Clinical Characteristics, Diagnosis, Treatment, and Clinical Outcomes of TB Patients at a Private University Hospital in Korea.: Seong Hoon Choi, Woo Sung Sun, Mi Na Kim, Tae Sun Shim; J Korean Acad Fam Med 2005;26(8):481-489. Published online August 10, 2005

Abstract
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Background
: Even though tuberculosis (TB) is still a major public concern in Korea, there are few data on the management of TB patients and its outcome in the private sector in contrast with those of the public sector.

Methods : The nine-hundred-twelve TB patients who were registered in a private university hospital from 2001 to 2002 were enrolled. The patients were divided into pulmonary (TB_P), extrapulmonary (TB_E), and combined (TB_P+E) groups, and were also divided into initial and retreatment groups. The clinical characteristics, diagnostic methods, treatment regimens, and outcomes were analyzed and compared between the groups.

Results : The mean age of 912 patients was 49.2 years and the male-to-female ratio was 56%:44%. The number of patients of the initial and retreatment groups of TB_P, and those of (TB_E+TB_P+E) were 449, 169, 237, 57, respectively. The bacteriological study was performed in 97.9%, and positive culture was confirmed in 54.5% and 29.6% of patients with TB_P and (TB_E+TB_P+E), respectively (P＜0.05). The AFB smear was positive in 40.8% of TB_P patients. The PCR was done in 63.6% of (TB_E+TB_P+E) group. The MDR was detected in 7.6% of isolates. Overall, treatment completion rate was 74.6%, default rate 13.7%, and death rate 0.5%.

Conclusion : Even though the management of TB patients in a private hospital was satisfactory in terms of national guidelines, the high default rate was still a problem. Efforts to decrease the default rate is needed independently or in cooperation with the public sector.

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A Case Report of Miliary Tuberculosis Diagnosed by Chest Computer Tomography in FUO.: Ji Bin Park, Sang Hyuk Han, Kyu Nam Kim, Seon Yeong Lee; J Korean Acad Fam Med 2004;25(5):397-402. Published online May 10, 2004

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This is a case report of miliary tuberculosis in adult with normal simple chest X-ray finding in early state of FUO. Miliary tuberculosis is fatal, which have nonspecific presenting symptoms. Then, a high index of suspicion and diagnostic persistence, are required for early treatment and cure.

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Compliance with anti-tuberculosis therapy of pulmonary tuberculosis patients.: Chang Woo Rhee, Choong Hun Han, Shin Ae Lim, Hong Jun Cho; J Korean Acad Fam Med 2000;21(5):684-692. Published online May 1, 2000

Abstract
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Background
: Tuberculosis is still one of the major public health problems in Korea. The patient's compliance with anti-tuberculosis therapy is the most important matter in managing tuberculosis. Research, particularly on this issue, is needed. Therefore, we analyzed the factors associated with compliance of pulmonary tuberculosis patients using the Health Belief Model.

Methods : One hundred and 47 patients who visited the outpatient Department of Family Medicine in Asan Medical Center from January 1995 to December 1998, and who were diagnosed as having pulmonary tuberculosis and treated with anti-tuberculosis drug were chosen through chart reviews. Questions were given by telephone with questionnaire based on Health Belief Model.

Results : One hundred and two patients out of the total 147 participated in the study. The group was divided into two: 79 patients as a compliance group, and 23 as a non-compliance group. Recognition of their diagnosis, recognition of the duration of taking anti-tuberculosis drugs, disturbance of daily living with taking the drugs, efficacy expectations were statistically significant factors between the two groups.

Conclusion : Higher the knowledge about their diagnosis as having tuberculosis, higher their knowledge about the durations of having to take the anti-tuberculosis drugs, less disturbance they had experieced on their daily living, and higher their expectation for the efficacies of taking the drugs resulted in higher compliance with anti-tuberculosis medication.

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A Study on the Fallow up of the Adolescents with Tuberculosis on Mass Miniature Radiography in Seoul.: Bom Taeck Kim, Jae Yong Shim, Hye Ree Lee; J Korean Acad Fam Med 1998;19(2):118-124. Published online February 1, 1998

Abstract
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Background
: Despite the declining tendency of the prevalence of tuberculosis in Korea, pulmonary tuberculosis is still considered to be such an important disease in Korea that tuberculosis of patients have been screened by mass miniature radiography(MMR). Although the prevalence of tuberculosis increases with age, screening of it has been done on students and young workers. There hasn't been any study about the prevalence of tuberculosis in adolescents recently.

Methods : MMR were performed on high school freshmen in Seoul from March to September, 1995. Patients with abnormal MMR were further evaluated on history taking and standard chest X-ray, Their results were classified as normal, active tuberculosis, activity-undetermined tuberculosis, healed tuberculosis, and other diseases. The prevalence of active tuberculosis by this screening method was estimated.

Results : Among 194,102 high school freshmen, 388 were suspected to have pulmonary tuberculosis by MMR. The prevalence of tuberculosis in high school freshmen in Seoul was 0.20%, male 0.18%, female 0.23% by MMR respectively, There was significant difference between the prevalences of both sexes. History taking and standard X-ray was taken for 94 students and among them 68 students were found to have active tuberculosis(72.3%), 14 normal(14.9%), 3 other diseases(3.2%), 9 healed or activity-undetermined tuberculosis(9.6%). Newly-diagnosed patients in active tuberculosis were 59(82.9%). There were family history in 31 out of 94 students(33.0%) and 29 out of 68 students(37.1%) with active pulmonary tuberculosis had family history of tuberculosis.

Conclusion : The prevalence of pulmonary tuberculosis in high school freshmen in Seoul was 0.20% by MMR. Positive predictive value of MMR was 72.3% in follow-up students by standard chest X-ray. Therefore estimated prevalence of active pulmonary tuberculosis by standard chest X-ray after MMR was 0.14%.