Department of Rheumatology and Immunology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Int J Rheum Dis. 2023 Jun;26(6):1143-1148. doi: 10.1111/1756-185X.14585. Epub 2023 Feb 1.
To analyze the clinical features of lupus-like tuberculosis (TB).
Three cases of TB imitating systemic lupus erythematosus (SLE) flare were collected in our hospital. Based on literature review, there are only 3 reports of TB resembling lupus flare rather than SLE per se.
The 3 cases of lupus mimickers, with a mean age of 30.3 years, ranging from 27 to 32 years, had atypical features of SLE, namely no typical butterfly erythema, lupus hair, alopecia or proteinuria, similar to the patients reported in the 3 previously mentioned studies. Emergence of different autoantibodies like anti-nuclear antibodies, anti-double-stranded DNA, anti-nucleosome antibodies, and anti-histone antibodies could occur in TB, mostly as an epiphenomenon. In patients with specific serological anti-Sm and hypocomplementemia, active TB cannot be easily ruled out. The presence of autoantibodies neither altered the clinical manifestations and radiographic findings of active TB, nor were detectable after infections are resolved. The resistance of the SLE manifestations to the steroid and immunosuppressive treatment suggests the contribution of an infectious disease.
TB stimulated the production of autoantibodies, with shared affinity for mycobacteria and human antigens, which may have led to lupus mimickers.
分析狼疮样结核病（TB）的临床特征。
收集我院 3 例酷似系统性红斑狼疮（SLE）发作的 TB。基于文献复习，仅有 3 例 TB 类似狼疮发作而非 SLE 本身的报道。
3 例狼疮样疾病患者，平均年龄 30.3 岁，年龄范围 27 至 32 岁，具有非典型 SLE 特征，即无典型蝶形红斑、狼疮发、脱发或蛋白尿，与之前 3 项研究中报道的患者相似。TB 中可能会出现不同的自身抗体，如抗核抗体、抗双链 DNA、抗核小体抗体和抗组蛋白抗体，多为伴随现象。在具有特定血清学抗 Sm 和低补体血症的患者中，活动性 TB 不易排除。自身抗体的存在既不会改变活动性 TB 的临床表现和影像学发现，也不会在感染得到解决后被检测到。SLE 表现对类固醇和免疫抑制治疗的耐药性表明与传染病有关。
TB 刺激了自身抗体的产生，这些抗体与分枝杆菌和人类抗原具有共同的亲和力，这可能导致狼疮样疾病。
