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Sistemik lupus eritematozus tanılıbir olguda akciğer, plevra ve bağırsak tüberkülozu: olgu sunumu

Year 2009, Volume 16, Issue 1, 34 - 38, 30.03.2009

Abstract

Süleyman Demirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2009 Mart; 16 (1) Sistemik lupus eritematozus tanılıbir olguda akciğer, plevra ve bağırsak tüberkülozu: olgu sunumu Şule Kaya*, Necla Songür*, Önder Öztürk*, Metin I.Çiriş**, Ercan Tunç***, Yıldıran Songür****, M. Cem Koçkar****, Ahmet Akkaya* Özet Sistemik Lupus Eritematozus (SLE), birçok organ sistemlerinin tutulumu ile karakterize otoimmün bir hastalıktır. Son zamanlarda, SLE hastalarında fırsatçı enfeksiyon riskinde, özellikle de akciğer tüberkülozu ve akciğer dışı organ tüberkülozunda artma olduğuna dair bir çok yayın bulunmaktadır. Altıyıldır SLE, diffüz proliferatif glomerülonefrit (DPGN) ve hipertansiyon tanılarıile takip edilen 35 yaşında bayan hasta üşüme, titreme, ateş, halsizlik ve kilo kaybıyakınmalarıile kliniğimize başvurdu. Akciğer grafisinde, sol akciğer orta ve alt zonda efüzyon ile uyumlu açıklığıyukarıbakan homojen dansite artışı izlendi. Hastanın öyküsünden 1 ay önce akut batın ön tanısıyla sağ hemikolektomi operasyonu geçirdiği öğrenildi. Ameliyat materyalinin patoloji sonucu kazeifikasyon nekrozu içeren granülomatöz inflamasyon ile uyumlu idi. Bronkoskopik biyopsilerde granülom görülmedi. Bronş lavajının direkt bakısında asido rezistan bakteri (ARB) negatifti ve aynımateryalin kültüründe ARB üremedi. Plevral sıvıda adenozin deaminaz düzeyi (ADA) 182U/L idi. Klinik ve laboratuar bulgularıile lupus aktivasyonu dışlanan olguda kullanmakta olduğu düşük doz kortizon tedavisine devam edildi. Bağırsak tüberkülozu, yayma negatif akciğer tüberkülozu ve tüberküloz plörezi tanıları ile antitüberküloz tedavi başlandı. Antitüberküloz tedavi ile klinik ve radyolojik düzelme görülen olguda tedavi 9 aya tamamlandı. Anahtar kelimeler: Akciğer tüberkülozu, akciğer dışı organ tüberkülozu, sistemik lupus eritematozus Abstract Pulmonary, pleural and intestinal tuberculosis in a case with the diagnosis of systemic lupus erythematosus: a case report Systemic lupus erythematosus (SLE) is an aotuimmune disease that characterized multisystem involvement. Recently, there are many reports about an increased risk for opportunistic infections, especially pulmonary and extrapulmonary tuberculosis in patients with SLE. A 35-year old female patient, who had been followed with the diagnosis of SLE, diffuse glomerulonephritis and hypertension for six years, admitted to our clinic with the complaints of chill, fever, fatigue and weight loss. The chest roentgenogram showed an increased homogenous density in the left middle and the basal lung zones. It was learned that the patient was undergone the operation of hemicolectomi with the diagnosis of acute abdomen one month ago. The pathological examination of the specimen was showed a granulomatous inflammation with caseification necrosis. Any granuloma was seen on the bronchoscopic biopsies. The direct examination and culture of the bronchial lavage for acid -fast bacilli was negative. The level of adenosine deaminase in pleural fluid was 182 U/L. With the laboratory and clinical findings, activation of lupus was excluded and the low dose cortisone therapy was continued. The antituberculosis treatment was given with the diagnosis of bowel tuberculosis, sputum smear negative pulmonary tuberculosis and tuberculous pleurisy. By the clinical and radiological improvement, the treatment was completed in 9 months. Key words: Pulmonary tuberculosis, extrapulmonary tuberculosis, systemic lupus erythematosus

References

  • Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997; 350: 575-580
  • Zumla A, James DG. Granulomatous infections: etiology and classification. Clin Infect Dis 1996; 23: 146-158
  • Fraser RS, Müler NL, Colman N, Pare PD. Connective tissue diseases. In: Diagnosis of Disease of The Chest. 4th ed. Philedelphia: WB Saunder Co,1999; 1421-88
  • Dubois EL, Tuffanelli DL. Clinical manifestations of systemic lupus erythematosus: computer analysis of 520 cases. JAMA 1964; 190: 104-111
  • Francisco P, Quismorio Jr. Pulmonary manifestations of systemic lupus erythematosus. In Wallace DJ, Hahn BD, eds. Dubois lupus erythematosus. 5th.ed. Baltimore: Williams and wilkins Comp, 1997: 673- 692
  • Good JT Jr, King TE, Antony VB, Sahn SA. Lupus Pleuritis: Clinical Factors and pleural Fluid Characteristics with special reference to pleural fluid antinuclear antibodies. Chest 1983; 84: 714-718
  • Michael PA, Lynch JP. Pleuropulmonary manifestations of systemic lupus erythematosus. Thorax 2000; 35: 159-166
  • Paton NI. Infections in systemic lupus erythematosus patients. Ann Acad Med Singapore 1997; 26: 694–700
  • Sayarlýoðlu M, Inanç M, Kamali S, Cefle A, Karaman O, Gul A, et al. Tuberculosis in Turkish Patients with Systemic Lupus Erythematosus: Increased Frequency of Extrapulmonary Localization. Lupus 2004;13: 274- 278
  • Ginzler E, Diamond H, Kaplan D, Weiner M, , . Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus. Arthritis and Rheum 1978; 21: 37-44
  • Noël V, Lortholary O, Casassus P, Cohen P, Généreau T, André MH, et al. Risk factors and prognostic infuence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 2001; 60: 1141–1144.
  • Yu CL, Chang KL, Chiu CC, Chiang BN, Han SH, Wang SR. Defective phagocytosis, decreased tumour necrosis factor-alpha production, and lymphocyte hyperresponsiveness predispose patients with systemic lupus erythematosus to infections. Scand J Rheumatol 1989; 18: 97-105.
  • Hernandez-Cruz B, Sifuentes-Osornio J, Ponce-de- Leon Rosales S, Ponce-de-Leon Garduno A, Diaz- Jouanen E. Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case series. Clin Exp Rheumatol 1999; 17: 289–296.

Year 2009, Volume 16, Issue 1, 34 - 38, 30.03.2009

Abstract

References

  • Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997; 350: 575-580
  • Zumla A, James DG. Granulomatous infections: etiology and classification. Clin Infect Dis 1996; 23: 146-158
  • Fraser RS, Müler NL, Colman N, Pare PD. Connective tissue diseases. In: Diagnosis of Disease of The Chest. 4th ed. Philedelphia: WB Saunder Co,1999; 1421-88
  • Dubois EL, Tuffanelli DL. Clinical manifestations of systemic lupus erythematosus: computer analysis of 520 cases. JAMA 1964; 190: 104-111
  • Francisco P, Quismorio Jr. Pulmonary manifestations of systemic lupus erythematosus. In Wallace DJ, Hahn BD, eds. Dubois lupus erythematosus. 5th.ed. Baltimore: Williams and wilkins Comp, 1997: 673- 692
  • Good JT Jr, King TE, Antony VB, Sahn SA. Lupus Pleuritis: Clinical Factors and pleural Fluid Characteristics with special reference to pleural fluid antinuclear antibodies. Chest 1983; 84: 714-718
  • Michael PA, Lynch JP. Pleuropulmonary manifestations of systemic lupus erythematosus. Thorax 2000; 35: 159-166
  • Paton NI. Infections in systemic lupus erythematosus patients. Ann Acad Med Singapore 1997; 26: 694–700
  • Sayarlýoðlu M, Inanç M, Kamali S, Cefle A, Karaman O, Gul A, et al. Tuberculosis in Turkish Patients with Systemic Lupus Erythematosus: Increased Frequency of Extrapulmonary Localization. Lupus 2004;13: 274- 278
  • Ginzler E, Diamond H, Kaplan D, Weiner M, , . Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus. Arthritis and Rheum 1978; 21: 37-44
  • Noël V, Lortholary O, Casassus P, Cohen P, Généreau T, André MH, et al. Risk factors and prognostic infuence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 2001; 60: 1141–1144.
  • Yu CL, Chang KL, Chiu CC, Chiang BN, Han SH, Wang SR. Defective phagocytosis, decreased tumour necrosis factor-alpha production, and lymphocyte hyperresponsiveness predispose patients with systemic lupus erythematosus to infections. Scand J Rheumatol 1989; 18: 97-105.
  • Hernandez-Cruz B, Sifuentes-Osornio J, Ponce-de- Leon Rosales S, Ponce-de-Leon Garduno A, Diaz- Jouanen E. Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case series. Clin Exp Rheumatol 1999; 17: 289–296.

Details

Primary Language English
Journal Section Olgu Sunumları
Authors

Şule Kaya This is me


Necla Songür This is me


Önder Öztürk This is me


Metin İ. Ciriş This is me


Ercan Tunç This is me


Yıldıran Songür This is me


M.Cem Koçkar This is me


Ahmet Akkaya This is me

Publication Date March 30, 2009
Submission Date June 1, 2009
Acceptance Date
Published in Issue Year 2009, Volume 16, Issue 1

Cite

Vancouver Kaya Ş. , Songür N. , Öztürk Ö. , Ciriş M. İ. , Tunç E. , Songür Y. , Koçkar M. , Akkaya A. Sistemik lupus eritematozus tanılıbir olguda akciğer, plevra ve bağırsak tüberkülozu: olgu sunumu. SDÜ Tıp Fakültesi Dergisi. 2009; 16(1): 34-38.

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