Tuberculosis infection in patients with systemic lupus erythematosus: pulmonary and extra-pulmonary infection compared

Abstract

Systemic lupus erythematosus (SLE) patients had an increased susceptibility to tuberculosis (TB). The aim of this study was to investigate the prevalence and clinical characteristics of TB in SLE patients, with focus on the differences between pulmonary and extra-pulmonary TB. This is a retrospective study that reviewed the medical records of 3,179 SLE patients from 1985 to 2004. The diagnosis of TB was confirmed by one of the following: positive acid-fast bacillus (AFB) smear, positive culture of Mycobacterium tuberculosis from appropriate specimens, or a histopathologic finding of caseating granuloma on specimen. During the 20-year review period, TB was documented in 19 SLE patients, with 21 episodes. Ten of 21 episodes (47.6%) were pulmonary TB while the other 11 episodes (52.4%) were extra-pulmonary TB. Among extra-pulmonary TB, there were joint and cutaneous involvements in five, miliary in two, Pott's disease in two, peritoneum in one, and spleen in one. The most common manifestations of TB were fever and cough. Delayed diagnosis and adverse effects of anti-TB therapy were observed in the extra-pulmonary TB group. While SLE patients commonly present with prolonged fever or chronic cough, tuberculosis infection should be taken into consideration.

SLE and Tuberculosis: A Case Series and Review of Literature

“…A 24-year-old female previously diagnosed to have SLE with Class IV Lupus Nephritis one year back based upon American College of Rheumatology (ACR) criteria [9] on immunosuppressive therapy with corticosteroids and mycophenolate mofetil presented with history of cough with expectoration for two weeks associated with fever for the same duration. She had history of contact with a case of TB in her household.…”

“…A 19-year-old female previously diagnosed to have SLE three months back based upon American College of Rheumatology (ACR) criteria [9], on corticosteroids and hydroxychloroquine sulphate presented with history of fever for three weeks, polyarthralgia and difficulty in breathing. She had no history of contact with a case of TB.…”

“…A 24-year-old female recently diagnosed to have SLE with Class IV lupus nephritis 2 months back based upon ACR criteria and renal biopsy [9], on corticosteroids and cyclophosphamide therapy presented with history of high grade fever for two weeks and difficulty in breathing. On evaluation she was febrile (Temperature: 103°F) with a blood pressure of 80/60 mmHg and pulse rate of 130/min and respiratory rate of 28/min.…”

Infecciones en pacientes reumatológicos asociadas a corticosteroides y antagonistas del factor de necrosis tumoral α

“…Otros factores independientes a la dosis diaria que concurren en estos pacientes son diabetes mellitus, un IMC < 20 kg/m 2 , tabaquismo actual y EPOC 14 . La TBC en estos pacientes se presenta como cuadros pulmonares y con una alta frecuencia como formas extra-pulmonares 15 .…”

Management of infection in systemic lupus erythematosus

“…In an individual patient, the differential diagnosis is crucial. In a retrospective analysis involving more than 3000 SLE patients, Hou et al [33] documented 19 lupus patients with 21 episodes, 10 of which were pulmonary while the other 11 episodes were extrapulmonary (joint, cutaneous or visceral-organ involvement). Fever and cough were found to be the most common manifestations of tuberculosis.…”