Cerqueira Ana, Seco Tiago, Paiva David, Martins Helio, Cotter Jorge
Internal Medicine, Hospital Senhora Da Oliveira, Guimarães, PRT.
Cureus. 2020 Mar 18;12(3):e7311. doi: 10.7759/cureus.7311.
A 50-year-old female with a past medical history of bone tuberculosis diagnosed nine months ago was admitted in our infirmary for persistent fever with no evident cause. The patient was treated with isoniazid, rifampicin, pyrazinamide, and ethambutol for seven months and for the past two months, she was taking isoniazid and rifampicin. She went to our emergency room (ER) for back pain and fever that she had been experiencing for the last month. She was admitted with suspicion of disseminated tuberculosis that was never confirmed. Physical examination was unremarkable. Blood tests showed an elevation of inflammation parameters. A computed tomography (CT) scan of the chest showed a mild pleural effusion. She remained with fever during the three weeks in the infirmary while undergoing many other studies that were all negative. The back pain would change sides, and three consecutive thoracic radiographies showed a small-sized pleural effusion that was either predominantly right-sided or left-sided. Several differential diagnoses were considered in the process, namely an active infection, neoplasia, or autoimmune disease. The search for circulating lupus anticoagulant was positive. Antinuclear antibodies (ANA) were positive and the anti-histone antibody was strongly positive. At this point, we suspected a drug-induced lupus diagnosis, and isoniazid was discontinued. Following discontinuation of isoniazid, back pain and fever subsided and patient was discharged after one week. This case is a diagnostic challenge because of the rarity and symptom severity of isoniazid-induced lupus. Isoniazid rarely induced this lupus-like syndrome, with an incidence of considerably less than 1%.
一名50岁女性，9个月前被诊断为骨结核，因持续发热且无明显病因入住我院。患者接受异烟肼、利福平、吡嗪酰胺和乙胺丁醇治疗7个月，在过去两个月中，她一直在服用异烟肼和利福平。她因过去一个月一直经历的背痛和发热前往我院急诊室。她因怀疑播散性结核入院，但从未得到证实。体格检查无异常。血液检查显示炎症指标升高。胸部计算机断层扫描（CT）显示有少量胸腔积液。她在我院住院三周期间持续发热，同时进行了许多其他检查，结果均为阴性。背痛会改变部位，连续三次胸部X光检查显示有少量胸腔积液，主要为右侧或左侧。在此过程中考虑了几种鉴别诊断，即活动性感染、肿瘤或自身免疫性疾病。循环狼疮抗凝物检测呈阳性。抗核抗体（ANA）呈阳性，抗组蛋白抗体呈强阳性。此时，我们怀疑是药物性狼疮诊断，停用了异烟肼。停用异烟肼后，背痛和发热消退，患者一周后出院。由于异烟肼诱导的狼疮罕见且症状严重，该病例是一个诊断挑战。异烟肼很少诱发这种狼疮样综合征，发病率远低于1%。
