Lupus Pneumonitis Masquerading as Pulmonary Tuberculosis–A Case Study

Abstract

Arthritis J o u rn al of Ar th r it is ISSN: 2167-7921Bhattacharya et al., J Arthritis 2015, 4:4 http://dx.doi. org/10.4172/2167-7921.1000171 Keywords: Systemic lupus erythematosus; Lupus pneumonitis; Pulmonary tuberculosis; Differential diagnosis Introduction SLE (Systemic lupus erythematosus) is a multisystem autoimmune disorder which has a waxing and waning course. The clinical manifestations of SLE are variable. They include erythematous photosensitive malar rash, oral ulcers, non-erosive polyarthritis or polyarthralgia, polyserositis, immune-mediated cytopenias, renal, neurologic, pulmonary and cardiac abnormalities. Pulmonary manifestations of SLE were first described by Osler in 1904 who described a patient of SLE with persistent lower lobe infiltrates [1]. A wide spectrum of pulmonary presentations has since been described, which include as pleuritis, pneumonia, pulmonary embolism, pneumothorax and pulmonary haemorrhage [2]. Though infections are a frequent cause of pulmonary infiltrates in patients with SLE, in many cases pulmonary infiltrates are not related to infection [1]. Lupus pneumonitis (LP) is an unusual and life threatening complication of SLE usually occurring during SLE flare-ups, but rarely as a presenting feature. Acute LP may mimic tuberculosis or other acute infectious pneumonia and its incidence varies from 0.9% to 11.7% [3]. Hence a high index of clinical suspicion should be kept, when young females present with unexplained pulmonary infiltrates, especially in tuberculosis endemic countries like India where use of empirical antitubercular therapy is high. We hereby report a case of LP as a presenting feature of SLE, thereby mimicking pulmonary tuberculosis. Case ReportAn 18 years old female was admitted to the hospital with complaints of low grade fever for 2 months, cough with mucoid expectoration for 3 weeks, blood streaked sputum for 1 week and difficulty in breathing for three days prior to admission. She had a history of swelling of hands and feet, off and on, for the past one year although she denied any specific history of joint pain. There was history of irregular menstruation and loss of hair. There was no history of palpitations, breathlessness, weight loss, or exposure to any drugs or toxins. She also gave history of contact with a case of pulmonary tuberculosis in her family. Past medical history was unremarkable and there was no history of travel in the recent past. Her bowel and bladder habits were normal.On examination she was fully conscious and oriented. Her blood pressure was 100/60 mm of Hg. She had tachycardia (pulse rate 106/ min), tachypnoea (respiratory rate -26/min) with dyspnoea, as evidenced by the use of accessory muscles of respiration, fever (oral temperature of 101 0 F). There was presence of pallor and grade-1 diffuse alopecia. On respiratory examination, there were diffuse bilateral coarse crepitations over her chest. Cardiac examination revealed a grade II soft systolic murmur with a prominent pulmonary component AbstractIntroduction: Systemic Lupus...