Hernández-Cruz B, Sifuentes-Osornio J, Ponce-de-León Rosales S, Ponce-de-León Garduño A, Díaz-Jouanen E
Department of Internal Medicine, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
Clin Exp Rheumatol. 1999 May-Jun;17(3):289-96.
To describe the clinical characteristics of patients with systemic rheumatic diseases and tuberculosis. A retrospective case series from 1987 to 1994, drawn from a tertiary-care hospital in Mexico City, was studied.
Thirty patients were included (20 women, 10 men), with mean age of 39.8 years (range 14-66), and a mean duration of the systemic rheumatic disease of 44 months (1-372). The rheumatic diseases included systemic lupus erythematosus (SLE) (n = 13), rheumatoid arthritis (7), polymyositis or dermatomyositis (5), and other diseases (5). During the six months previous to the diagnosis of tuberculosis, 22 patients had received corticosteroids, and 13 others immunosuppressants. Mycobacterium tuberculosis was isolated from 18 patients. Pulmonary tuberculosis was found in 10 patients, and extrapulmonary tuberculosis in 20, seven of these with miliary disease. SLE was seen in 6 of the patients with miliary tuberculosis. The clinical manifestations were: fever (67%), weight loss (67%), diaphoresis (60%), cough and sputum (53%), lymph node enlargement (43%), and dyspnea (33%). Sixteen patients had an abnormal chest film. Of 18 patients tested by PPD RT-2, 8 had an induration > 10 mm. Patients were initially treated with 3 or 4 anti-tuberculosis drugs for 15 days to 6 months, followed by 6 to 10 months of isoniazid plus rifampicin. Three relapsed, and 2 died of respiratory failure.
This case series showed a particular pattern of tuberculosis in patients with systemic rheumatic diseases.
描述系统性风湿疾病合并结核病患者的临床特征。对1987年至1994年来自墨西哥城一家三级护理医院的回顾性病例系列进行研究。
纳入30例患者（20例女性，10例男性），平均年龄39.8岁（范围14 - 66岁），系统性风湿疾病平均病程44个月（1 - 372个月）。风湿疾病包括系统性红斑狼疮（SLE）（n = 13）、类风湿关节炎（7例）、多发性肌炎或皮肌炎（5例）以及其他疾病（5例）。在结核病诊断前的6个月内，22例患者接受了皮质类固醇治疗，另外13例接受了免疫抑制剂治疗。18例患者分离出结核分枝杆菌。10例患者发现肺结核，20例为肺外结核，其中7例为粟粒性疾病。粟粒性肺结核患者中有6例患有SLE。临床表现为：发热（67%）、体重减轻（67%）、多汗（60%）、咳嗽咳痰（53%）、淋巴结肿大（43%）以及呼吸困难（33%）。16例患者胸部X线片异常。在18例接受PPD RT - 2检测的患者中，8例硬结>10 mm。患者最初接受3或4种抗结核药物治疗15天至6个月，随后接受6至10个月的异烟肼加利福平治疗。3例复发，2例死于呼吸衰竭。
该病例系列显示了系统性风湿疾病患者结核病的一种特殊模式。
