Recurrence of tuberculosis as a cerebral abscess in a patient with systemic lupus erythematosus

Yıl 2013, Cilt: 18 Sayı: 1, 37 - 40, 02.05.2013

Felipe Montes Pena Raphael Freitas Jaber De Oliveira Andréya Moreira De Souza Soares Machado

Öz

Abstract. Infections are a major cause of morbidityand mortality in patients with systemic lupus erythematosus (SLE). Treatmentwith immunosuppressive drugs can decrease the clonal proliferation of T cellsand is the main predisposing factor for tuberculosis (TB). Clinically, theextrapulmonary TB is frequent in patients with SLE due to reactivation oflatent foci of primary infection or simply a reinfection. A case of young womanwho presented with cerebral TB. The diagnosis was established by biopsy, whichshowed chronic granulomatous inflammation with areas of central necrosis, withisolated Mycobacterium tuberculosis. There is increasing evidence suggesting anincreased severity of TB in SLE patients. This report demonstrates thenecessity of monitoring the increased susceptibility to infections in SLEpatients.Key words: Tuberculosis, systemic lupus erythematosus, cerebral abscess

Anahtar Kelimeler

Tuberculosis, systemic lupus erythematosus, cerebral abscess

Kaynakça

• Kim HA, Oyo CD, Beak HC, et al. Mycobacterium tuberculosis infection in a corticosteroid – treated rheumatic disease patient population. Cli Exp Rheum 1998; 16: 9-13.
• Raja A. Immunology of Tuberculosis. Indian J Med Res 2004; 120: 213-232.
• Navarra SV, Leynes MS. Infections in systemic lupus erythematosus. Lupus 2010; 19: 1419-1424.
• Vargas PJ, King G, Navarra SV. Central nervous system infections in Filipino patients with systemic lupus erythematosus. Int J Rheum Dis 2009; 12: 234-2
• Ruiz-Irastorza G, Olivares N, Ruiz-Arruza I, et al. Predictors of major infections in systemic lupus erythematosus. Arthritis Res Ther 2009; 11: 109
• Zhang L, Wang DX, Ma L. A clinical study of tuberculosis infection in systemic lupus erythematosus. Zhonghua Nei Ke Za Zhi 2008; 47: 808-8
• Lewinsohn DA, Heinzel A, Garadner JM, Mycobacterium tuberculosis specific CD8 T cell preferentially recognize heavily infected cells. Am J Respir Crit Care Med 2003; 168: 1346-1352.
• Tam LS, Li EK, Wong SM, et al. Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong. Scand J Rheumatol 2002; 31: 296-300.
• Hill HM, Kirshbaum JD. Military tuberculosis developing during prolonged cortisone therapy of systemic lupus erythematosus. Ann Intern Med 1956; 44: 781-790.
• Mahuad C, Bay ML, Farroni MA, et al. Cortisol and dehydroepiandrosterone affect the response of peripheral blood mononuclear cells to mycobacterial antigens during tuberculosis. Scand J Immunol 2004; 60: 639-646.
• Morris RE. Mechanisms of action of new immunosuppressive drugs. Ther Drug Monit 1995; 17: 564-569.
• Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmun Rev 2008; 8: 147-152. van Eden U, Holoshitz J, Nevo Z, et al. Arthritisinduced by a T-lymphocyte clone that responds to Mycobacterium tuberculosis and to cartilage proteoglycans. Proc Natl Acad Sci 1985; 82:5117-5120.
• Sayarlioglu M, Inanc M, Kamali S, et al. Tuberculosis in Turkish patients with systemic lupus erythematosus: Increased frequency of extrapulmonary localization. Lupus 2004; 13: 2742
• Bandyopadhyay D, Gupta S, Banerjee S, et al. Adenosine deaminase estimation and multiplex polymerase chain reaction in diagnosis of extrapulmonary tuberculosis. Int J Tuberc Lung Dis 2008; 12: 1203-1208.
• Silva JBJ. Tuberculose: Guia de Vigilancia Epidemiologica. J Bras Pneumol 2004; 30: 57-86.