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Tuberculosis infection in patients with systemic lupus erythematosus: pulmonary and extra-pulmonary infection compared

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Abstract

Systemic lupus erythematosus (SLE) patients had an increased susceptibility to tuberculosis (TB). The aim of this study was to investigate the prevalence and clinical characteristics of TB in SLE patients, with focus on the differences between pulmonary and extra-pulmonary TB. This is a retrospective study that reviewed the medical records of 3,179 SLE patients from 1985 to 2004. The diagnosis of TB was confirmed by one of the following: positive acid-fast bacillus (AFB) smear, positive culture of Mycobacterium tuberculosis from appropriate specimens, or a histopathologic finding of caseating granuloma on specimen. During the 20-year review period, TB was documented in 19 SLE patients, with 21 episodes. Ten of 21 episodes (47.6%) were pulmonary TB while the other 11 episodes (52.4%) were extra-pulmonary TB. Among extra-pulmonary TB, there were joint and cutaneous involvements in five, miliary in two, Pott’s disease in two, peritoneum in one, and spleen in one. The most common manifestations of TB were fever and cough. Delayed diagnosis and adverse effects of anti-TB therapy were observed in the extra-pulmonary TB group. While SLE patients commonly present with prolonged fever or chronic cough, tuberculosis infection should be taken into consideration.

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References

  1. Ward MM, Pyun E, Studenski S (1995) Causes of death in systemic lupus erythematosus. Long-term followup of an inception cohort. Arthritis Rheum 38:1492–1499

    Article  PubMed  CAS  Google Scholar 

  2. Tsao CH, Chen CY, Ou LS, Huang JL (2002) Risk factors of mortality for salmonella infection in systemic lupus erythematosus. J Rheumatol 29:1214–1218

    PubMed  Google Scholar 

  3. Hung JJ, Ou LS, Lee WI, Huang JL (2005) Central nervous system infections in patients with systemic lupus erythematosus. J Rheumatol 32:40–43

    PubMed  Google Scholar 

  4. Wu KC, Yao TC, Yeh KW, Huang JL (2004) Osteomyelitis in patients with systemic lupus erythematosus. J Rheumatol 31:1340–1343

    PubMed  Google Scholar 

  5. Sayarlioglu M, Inang M, Kamali S et al (2004) Tuberculosis in Turkish patients with systemic lupus erythematosus: increased frequency of extrapulmonary localization. Lupus 13:274–278

    Article  PubMed  CAS  Google Scholar 

  6. Paton NI (1997) Infections in systemic lupus erythematosus patients. Ann Acad Med Singapore 26:694–700

    PubMed  CAS  Google Scholar 

  7. Tam LS, Li EK, Wong SM, Szeto CC (2002) Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong. Scand J Rheumatol 31:296–300

    Article  PubMed  Google Scholar 

  8. Balakrishnan C, Mangat G, Mittal G, Joshi VR (1998) Tuberculosis in patients with systemic lupus erythematosus. J Assoc Physicians India 46:682–683

    PubMed  CAS  Google Scholar 

  9. Feng PH, Tan TH (1982) Tuberculosis in patients with systemic lupus erythematosus. Ann Rheum Dis 41:11–14

    Article  PubMed  CAS  Google Scholar 

  10. Victorio-Navarra ST, Dy EE, Arroyo CG, Torralba TP (1996) Tuberculosis among Filipino patients with systemic lupus erythematosus. Semin Arthritis Rheum 26:628–634

    Article  PubMed  CAS  Google Scholar 

  11. Pryor BD, Bologna SG, Kahl LE (1996) Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus. Arthritis Rheum 39:1475–1482

    Article  PubMed  CAS  Google Scholar 

  12. Noel V, Lortholary O, Casassus P et al (2001) Risk factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 60:1141–1144

    Article  PubMed  CAS  Google Scholar 

  13. Paton NI, Cheong IK, Kong NC, Segasothy M (1996) Risk factors for infection in Malaysian patients with systemic lupus erythematosus. QJM 89:531–538

    PubMed  CAS  Google Scholar 

  14. Hernandez-Cruz B, Sifuentes-Osornio J, Ponce-de-Leon RS, Ponce-de-Leon GA, Diaz-Jouanen E (1999) Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case-series. Clin Exp Rheumatol 17:289–296

    CAS  Google Scholar 

  15. Tan EM, Cohen AS, Fries JF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277

    Article  PubMed  CAS  Google Scholar 

  16. Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35:630–640

    Article  PubMed  CAS  Google Scholar 

  17. Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C (2003) Tuberculosis. Lancet 362:887–899

    Article  PubMed  Google Scholar 

  18. Corett EL, Watt CJ, Walker N et al (2003) The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 163:1009–10021

    Article  Google Scholar 

  19. de Luis A, Pigrau C, Pahissa A, Fernandez F, Matinez-Vazquez JM (1990) Infections in 96 cases of systemic lupus erythematosus. Med Clin (Barc) 94:607–610

    Google Scholar 

  20. Gaitinde S, Pathan E, Sule A, Mittal G, Joshi VR (2002) Efficacy of isoniazid prophylaxis in patients with systemic lupus erythematosus receiving long term steroid treatment. Ann Rheum Dis 61:251–253

    Article  Google Scholar 

  21. Huang JL, Lin CJ, Hung IJ, Luo SF (1994) The morbidity and mortality associated with childhood onset systemic lupus erythematosus. Chang Gung Med J 17:113–120

    CAS  Google Scholar 

  22. Dessein PH, Gledhill RF, Rossouw DS (1988) Systemic lupus erythematosus in black South Africans. S Afr Med J 74:387–389

    PubMed  CAS  Google Scholar 

  23. Rovensky J, Kovalancik M, Kristufek P et al (1996) Contribution to the problem of occurrence of tuberculosis in patients with systemic lupus erythematosus. Z Rheumatol 55:180–187

    PubMed  CAS  Google Scholar 

  24. Yun JE, Lee SW, Kim TH et al (2002) The incidence and clinical characteristics of Mycobacterium tuberculosis infection among systemic lupus erythematosus and rheumatoid arthritis patients in Korea. Clin Exp Rheumatol 20:127–132

    PubMed  CAS  Google Scholar 

  25. Small PM, Fujiwara RA PI (2001) Management of tuberculosis in the United States. N Engl J Med 345:189–200

    Article  PubMed  CAS  Google Scholar 

  26. Ilgazli A, Boyaci H, Basyigit I, Yildiz F (2004) Extrapulmonary tuberculosis: clinical and epidemiologic spectrum of 636 cases. Arch Med Res 35:435–441

    Article  PubMed  Google Scholar 

  27. Division of Tuberculosis Control, BC Centre for Disease Control (1998) Annual Report. Vancouver, B.C., Canada: Centre for Disease Control

  28. Le Moing V, Leport C (1998) Infections and lupus. Rev Prat 48:637–642

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Chih-Lung Hou, Yi-Chan Tsai, Li-Chen Chen & Jing-Long Huang

  2. Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Children’s Hospital, 5, Fu-Hsin St., Kueishan, Taoyuan, Taiwan

    Chih-Lung Hou, Yi-Chan Tsai, Li-Chen Chen & Jing-Long Huang

  3. Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan

    Chih-Lung Hou, Yi-Chan Tsai, Li-Chen Chen & Jing-Long Huang

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  1. Chih-Lung Hou
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  2. Yi-Chan Tsai
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  3. Li-Chen Chen
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  4. Jing-Long Huang
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Correspondence to Jing-Long Huang.

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Hou, CL., Tsai, YC., Chen, LC. et al. Tuberculosis infection in patients with systemic lupus erythematosus: pulmonary and extra-pulmonary infection compared. Clin Rheumatol 27, 557–563 (2008). https://doi.org/10.1007/s10067-007-0741-8

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  • DOI: https://doi.org/10.1007/s10067-007-0741-8

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