2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine.
Rheumatol Int. 2023 Nov;43(11):2131-2139. doi: 10.1007/s00296-023-05400-8. Epub 2023 Jul 31.
Patients with systemic lupus erythematosus (SLE) are at increased risk of tuberculosis (TB) infection due to immune dysfunction and immunosuppressive therapy. We present a case study of a 40-year-old woman with systemic lupus erythematosus (SLE). Initially, she was diagnosed with a lupus flare based on her clinical symptoms and laboratory results. However, upon further investigation, positive polymerase-chain reaction results for M. tuberculosis in the cerebrospinal fluid and lung parenchymal changes on chest computed tomography scan were indicative of TB infection. There was initial uncertainty regarding whether TB had triggered a flare-up of SLE or if TB was merely mimicking the symptoms of a SLE flare-up. However, as increasing the prednisolone dose did not have a positive effect and the patient's condition improved significantly with anti-TB treatment alone, it became clearer that the deterioration observed upon admission was primarily due to TB progression rather than an SLE flare-up. Additionally, we review the current literature on TB and SLE, including risk factors, diagnostic challenges, and treatment considerations, highlighting the importance of considering TB infection in patients with SLE who present with overlapping manifestations. Prompt diagnosis and treatment are essential for improving outcomes in these patients.
系统性红斑狼疮（SLE）患者由于免疫功能障碍和免疫抑制治疗，感染结核（TB）的风险增加。我们报告了一例 40 岁女性系统性红斑狼疮（SLE）患者的病例研究。最初，根据她的临床症状和实验室结果，她被诊断为狼疮发作。然而，进一步调查显示，脑脊液中结核分枝杆菌聚合酶链反应阳性结果和胸部 CT 扫描肺实质改变提示 TB 感染。最初不确定 TB 是否引发了 SLE 发作，或者 TB 是否仅仅是模仿了 SLE 发作的症状。然而，由于增加泼尼松龙剂量没有产生积极效果，并且仅用抗 TB 治疗患者的病情明显改善，因此可以更清楚地看出入院时观察到的恶化主要是由于 TB 进展而不是 SLE 发作。此外，我们回顾了关于 TB 和 SLE 的当前文献，包括风险因素、诊断挑战和治疗注意事项，强调了在表现重叠的 SLE 患者中考虑 TB 感染的重要性。及时诊断和治疗对于改善这些患者的预后至关重要。
