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病例报告:年轻女性结核病性淋巴结炎伴系统性红斑狼疮:病例报告。

Case Report: Tuberculosis lymphadenitis with systemic lupus erythematosus in a young woman: a case report.

机构信息

Pulmonology and Respiratory Medicine, Rumah Sakit Umum Daerah Dr Zainoel Abidin, Banda Aceh, Aceh, Indonesia.

Pulmonology and Respiratory Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia.

出版信息

F1000Res. 2023 Oct 16;12:763. doi: 10.12688/f1000research.135076.2. eCollection 2023.

DOI:10.12688/f1000research.135076.2
PMID:37965587
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10643883/
Abstract

: Tuberculosis is a chronic infectious disease and can be categorised into pulmonary TB and extra-pulmonary TB based on its spread. TB lymphadenitis is one of the extra-pulmonary TB diseases. Patients with a weakened immune system in systemic lupus erythematosus (SLE) have an increased incidence of TB. : Here we present a case report of a 21-year-old female patient with SLE diagnosed with tuberculous lymphadenitis at dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The patient complained of a lump in the right neck 4 months ago with a diameter of 4 cm, accompanied by fever, decreased appetite, and weight loss. Other than that, the patient also experiences joint pain, hair loss and sun sensitivity since 12 months ago. Chest radiography showed no abnormalities, and fine-needle aspiration biopsy results confirmed tuberculous lymphadenitis. Antinuclear antibody test was borderline. The patient had been taking steroids and hydroxychloroquine for the past 10 months. Currently, the patient is taking the advanced phase of antituberculosis drugs FDC. After undergoing the intensive phase of antituberculosis drugs, the submandibular lump got smaller to a diameter of 2 cm. : TB lymphadenitis is a rare case but can occur in conditions of decreased immunity like SLE. It involves some of the immune disorders caused by the long-term use of immunosuppressive therapy.

摘要

结核病是一种慢性传染病,根据其传播方式可分为肺结核和肺外结核。结核性淋巴结炎是肺外结核疾病之一。系统性红斑狼疮(SLE)患者的免疫系统较弱,患结核病的几率增加。

这里我们报告了一例 21 岁女性 SLE 患者,在印度尼西亚亚齐占碑的 Zainoel Abidin 医院被诊断为结核性淋巴结炎。患者 4 个月前出现右侧颈部肿块,直径 4 厘米,伴有发热、食欲不振和体重减轻。此外,患者还出现关节痛、脱发和日晒敏感,自 12 个月前开始。胸部 X 线检查未见异常,细针抽吸活检结果证实为结核性淋巴结炎。抗核抗体试验呈临界阳性。患者过去 10 个月一直在服用类固醇和羟氯喹。目前,患者正在服用抗结核药物 FDC 的晚期。在接受抗结核药物强化期治疗后,颌下肿块缩小至直径 2 厘米。

结核性淋巴结炎是一种罕见病例,但在像 SLE 这样免疫力下降的情况下可能会发生。它涉及到一些由长期使用免疫抑制疗法引起的免疫紊乱。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f2a/10643927/db56da4d195d/f1000research-12-157467-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f2a/10643927/a70ee2ce649b/f1000research-12-157467-g0000.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f2a/10643927/690c40ecb48f/f1000research-12-157467-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f2a/10643927/db56da4d195d/f1000research-12-157467-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f2a/10643927/a70ee2ce649b/f1000research-12-157467-g0000.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f2a/10643927/690c40ecb48f/f1000research-12-157467-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f2a/10643927/db56da4d195d/f1000research-12-157467-g0002.jpg

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本文引用的文献

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Cureus. 2022 Jun 28;14(6):e26410. doi: 10.7759/cureus.26410. eCollection 2022 Jun.
2
Tuberculosis Among Patients With Systemic Lupus Erythematosus in Indonesia: A Cohort Study.印度尼西亚系统性红斑狼疮患者中的结核病:一项队列研究
Open Forum Infect Dis. 2022 Apr 12;9(7):ofac201. doi: 10.1093/ofid/ofac201. eCollection 2022 Jul.
3
Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study.
哥伦比亚系统性红斑狼疮患者活动性肺结核的相关因素:一项病例对照研究。
Clin Rheumatol. 2021 Jan;40(1):181-191. doi: 10.1007/s10067-020-05225-x. Epub 2020 Jun 11.
4
New therapeutic strategies in systemic lupus erythematosus management.系统性红斑狼疮治疗的新策略。
Nat Rev Rheumatol. 2019 Jan;15(1):30-48. doi: 10.1038/s41584-018-0133-2.
5
Systemic lupus erythematosus: Diagnosis and clinical management.系统性红斑狼疮:诊断与临床管理。
J Autoimmun. 2019 Jan;96:1-13. doi: 10.1016/j.jaut.2018.11.001. Epub 2018 Nov 16.
6
Corticosteroid dose and the risk of opportunistic infection in a national systemic lupus erythematosus cohort.全国系统性红斑狼疮队列中皮质类固醇剂量与机会性感染风险
Lupus. 2018 Oct;27(11):1819-1827. doi: 10.1177/0961203318792352. Epub 2018 Aug 13.
7
SLE and Tuberculosis: A Case Series and Review of Literature.系统性红斑狼疮与结核病:病例系列及文献综述
J Clin Diagn Res. 2017 Feb;11(2):OR01-OR03. doi: 10.7860/JCDR/2017/22749.9398. Epub 2017 Feb 1.
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Diagnosis and treatment of extrapulmonary tuberculosis.肺外结核的诊断与治疗
Tuberc Respir Dis (Seoul). 2015 Apr;78(2):47-55. doi: 10.4046/trd.2015.78.2.47. Epub 2015 Apr 2.
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J Postgrad Med. 2010 Jul-Sep;56(3):244-50. doi: 10.4103/0022-3859.68653.