Lúpus eritematoso sistêmico e tuberculose renal: descrição de nove Casos

Abstract

RESUMOObjetivo: O presente estudo tem por objetivo principal descrever uma série de nove casos de tuberculose (TB) renal em pacientes portadores de lúpus eritematoso sistêmico (LES) ocorridos em um período de seis anos em um hospital terciário do Nordeste brasileiro. Métodos: Foram identificados nove pacientes portadoras de LES com baciloscopia e/ou cultura de urina positivas para Mycobacterium tuberculosis no período de outubro de 1998 a novembro de 2004, por intermédio dos registros do Serviço de Microbiologia do Hospital Universitário Walter Cantídio. Foram coletados dados demográficos, dados sobre o LES e sobre a TB renal das respectivas pacientes. Resultados: Todas as pacientes eram do sexo feminino, com idade entre 19 e 58 anos. Quanto às características do LES, todas haviam tido nefrite lúpica em algum momento da evolução, das quais três haviam utilizado ciclofosfamida previamente à infecção. A dose média de prednisona antes do diagnóstico de TB renal variou entre 7, 5 e 20 mg/dia. O diagnóstico de TB renal foi feito por meio de cultura positiva em cinco pacientes e por intermédio de baciloscopia apenas em quatro pacientes. As manifestações laboratoriais mais freqüentes foram leucocitúria e hematúria. A recidiva da TB renal ocorreu em quatro pacientes. Conclusão: A ocorrência de TB renal em pacientes com LES deve ser suspeitada na presença de piúria estéril e/ou hematúria persistentes, em especial em populações de países em desenvolvimento.Palavras-chave: lúpus, tuberculose, renal, extrapulmonar, infecção. AbStRActObjective: The main objective of the present study was to describe a series of nine cases of renal tuberculosis (TB) in patients diagnosed with systemic lupus erythematosus (SLE) over a period of six years at a tertiary-level hospital in Northeastern Brazil. Methods: Nine SLE patients with renal TB confirmed by bacterioscopy (n=4) or urine culture (n=5) positive for M. tuberculosis between October 1998 and November 2004 were sampled from the records of the microbiology department of Hospital Universitário Walter Cantídio. Data were collected regarding demographics, SLE and renal TB. Results: All patients were female, aged between 19 and 58 years and had a history of lupus nephritis. Three had been on cyclophosphamide therapy prior to TB infection. The average dose of prednisone administered before the diagnosis of renal TB ranged between 7.5 and 20 mg/day. The most common laboratory findings were leukocyturia and hematuria. Renal TB recurred in four patients. Conclusion: The occurrence of renal TB in SLE patients should be suspected in the presence of persistent sterile pyuria and/or hematuria, especially in developing countries.

Can Lupus Flares be Associated with Tuberculosis Infection?

“…Nephritis has been reported in additional studies to be a risk factor for TB [14][15][16][17]. In this context, a recent study in Brazil reported nine cases of SLE and renal tuberculosis; all cases had nephritis [23]. The increased prevalence of arthritis and renal disease in SLE patients who developed TB might be a reflection of a more severe disease course, demanding a more aggressive therapeutic approach [14][15][16][17].…”

Tuberculous otomastoiditis in patient with lupus✰✰Please cite this article as: Hirata SC, Mendonça JC, Gurgel ACM, Petruco MV. Tuberculous ostomastoiditis in patient with lupus. Braz J Otorhinolaryngol. 2014;80:92–3.

“…1. , 2. Perhaps the foreknowledge that TOM in SLE is much more common than in the general population2 would have led to a more unequivocal investigation of this disease and more thorough consideration of surgical indication.…”

“…although it is significantly more common in SLE (3.6% to 11.6%). 2 The clinical triad of TOM is painless otorrhea, tympanic membrane perforation, and facial paralysis; ear pain can also be present. 4 Late diagnosis of TOM is common and associated with complications such as mastoiditis and hearing loss.…”