Qureshi Anum, Persaud Kia, Halilu Fatima, Rhee Ji Hyun
Department of Internal Medicine Greater Baltimore Medical Center, Towson, MD, USA.
Department of Pulmonary and Critical Care Medicine Greater Baltimore Medical Center, Towson, MD, USA.
J Community Hosp Intern Med Perspect. 2022 Jul 4;12(4):49-52. doi: 10.55729/2000-9666.1063. eCollection 2022.
Systemic lupus erythematosus (SLE) is an autoimmune disease with a myriad of clinical presentations and periodic flares. We present a case of a young lady with a history of SLE who presented with constitutional symptoms 1 week after starting Isoniazid and Rifampin for treatment of latent TB. Her presentation shared similarities with several diseases including TB lymphadenitis, SLE flare, Kikuchi-Fujimoto Disease (KFD) and hemophagocytic lymphohistiocytosis (HLH) posing a diagnostic dilemma. Additionally, she presented not long after the onset of the global COVID-19 pandemic, further expanding the differential diagnosis. She was ultimately diagnosed with a severe SLE flare caused by rifampin induced suppression of the CYP3A4 system, thereby reducing the therapeutic efficacy of steroids. This case highlights the deadly potential of drug-drug interactions, especially in patients with autoimmune conditions.
系统性红斑狼疮（SLE）是一种具有多种临床表现和周期性发作的自身免疫性疾病。我们报告一例有SLE病史的年轻女性病例，该患者在开始使用异烟肼和利福平治疗潜伏性结核1周后出现全身症状。她的表现与多种疾病相似，包括结核性淋巴结炎、SLE发作、菊池-藤本病（KFD）和噬血细胞性淋巴组织细胞增生症（HLH），这构成了诊断难题。此外，她在全球COVID-19大流行开始后不久出现症状，进一步扩大了鉴别诊断范围。她最终被诊断为利福平诱导的CYP3A4系统抑制导致的严重SLE发作，从而降低了类固醇的治疗效果。该病例突出了药物相互作用的致命潜力，尤其是在自身免疫性疾病患者中。
