We report the case of a 36-year-old man with psoriatic arthritis and miliary tuberculosis, whose serum uric acid (SUA) level increased after the initiation of antituberculosis treatment, which included pyrazinamide. Most strikingly and paradoxically, the patient's SUA level increased after treatment with allopurinol. On cessation of allopurinol, his SUA level decreased substantially, and complete normalisation was observed following the discontinuation of pyrazinamide treatment.
Adult ; Allopurinol ; therapeutic use ; Arthritis, Psoriatic ; drug therapy ; Humans ; Hyperuricemia ; chemically induced ; Male ; Pyrazinamide ; adverse effects ; Treatment Outcome ; Tuberculosis, Miliary ; drug therapy ; Uric Acid ; blood

Adult-onset Still's disease (AOSD) is an inflammatory disease that presents with a variety of clinical symptoms. Pulmonary involvement is well-known in AOSD and is seen in up to 53% of AOSD cases, with the most common pulmonary diseases being pleural effusion and transient pulmonary infiltrates. We present the first case of chronic AOSD complicated with diffuse alveolar hemorrhage during the acute flare of the disease.
Adult ; Ankylosis/diagnosis ; Anti-Inflammatory Agents/administration & dosage ; Diagnosis, Differential ; Female ; Fever of Unknown Origin/diagnosis ; Hemorrhage/*diagnosis/drug therapy/etiology ; Humans ; Lung Diseases/*diagnosis/drug therapy/etiology ; Methylprednisolone/administration & dosage ; *Pulmonary Alveoli ; Still's Disease, Adult-Onset/complications/*diagnosis/drug therapy/radiography ; Tomography, X-Ray Computed