Miliary tuberculosis mimicking systemic lupus erythematosus flare

Abstract

A 26-year-old woman was diagnosed with and treated for systemic lupus erythematosus (SLE) in 2002. She was admitted 11 years later with nephrotic-range proteinuria and lupus nephritis and received two doses of rituximab after failing on steroids and mycophenolate mofetil. Four months later, she presented with fever and joint pain/swelling. Gram stains, joint aspirates, and blood culture all yielded negative results for bacteria. She was discharged after treatment for a possible flare of lupus, but two weeks later, she presented again with a cough and shortness of breath in addition to the flare symptoms. Synovial fluid Smears, and cultures yielded positive results for Mycobacterium tuberculosis; similarly, sputum polymerase chain reaction test and culture confirmed pulmonary tuberculosis. Tuberculosis is difficult to diagnose in SLE patients; it may present like or precipitate SLE flare. In this patient a presumed SLE flare turned out to be an aggressive miliary, disseminated tuberculosis.

Etiopathogenesis, Challenges and Remedies Associated With Female Genital Tuberculosis: Potential Role of Nuclear Receptors

“…EPTB diagnosis is challenging because of misdiagnosis, arduousness in acquiring of clinical samples, being asymptomatic, and poor sensitivity of existing diagnostic (Figure 1). Generally, miliary TB is misdiagnosed with systemic lupus erythematosus (SLE) (38). EPTB, particularly peritoneal TB, may also be misinterpreted as ovarian cancer and peritoneal carcinomatosis (5,39).…”

Disseminierte Tuberkulose imitiert metastasiertes Magenkarzinom – ein Fallbericht

“…Tuberkulose gilt nach Syphilis als "der zweite große Imitator" der Medizin [21][22][23]: Besonders die disseminierte Tuberkulose kann viele andere Erkrankungen imitieren, insbesondere metastasierte Tumorerkrankungen [24][25][26][27] oder chronisch-entzündliche Erkrankungen [28,29]. Daher sollte bei unklaren konsumierenden Erkrankungen differenzialdiagnostisch unbedingt auch an eine Tuberkuloseerkrankung gedacht werden.…”