SLE and Tuberculosis: A Case Series and Review of Literature

Abstract

Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase in the risk of TB in SLE. Primary mechanisms pertaining to the increased susceptibility for TB are the inherent immunodeficient state of SLE and use of immunosuppressant agents in the treatment of SLE. We report a case series of five female patients of SLE with TB who presented between January 2015 and December 2015 in a tertiary care teaching hospital in North Eastern India. All the patients were young to middle aged females having SLE with or without lupus nephritis who were on immunosuppressive therapy with corticosteroids, mycophenolate mofetil or cyclophosphamide. Two of the cases had sputum positive pulmonary tuberculosis while rest had Extra-Pulmonary TB (EPTB). The response to anti-tubercular therapy led to clinical improvement in all the cases except one who had an adverse outcome. Our series further substantiates the increased risk of TB in SLE thus, prompting further research towards better management of these two disease entities in conjunction.

Keywords: Auto-immunity; Immunosuppression; Lupus; Tubercular infection.

[Table/Fig-1]:

Chest X-ray showing bilateral patchy infiltrates with a left sided pleural effusion.

[Table/Fig-2]:

Chest X-ray showing cardiomegaly.

[Table/Fig-3]:

2–D echocardiography showing moderate pericardal effusion.

[Table/Fig-4]:

Chest X-ray showing cardiomegaly with left sided pleural effusion.

[Table/Fig-5]:

MRI brain showing abscess in the right side of the midbrain along with well defined rim enhancing lesions suggestive of tubercular brain abscess with tuberculomas.