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

Yıl 2009, Cilt: 16 Sayı: 1, 34 - 38, 30.03.2009

Şule Kaya Necla Songür Önder Öztürk Metin İ. Ciriş Ercan Tunç Yıldıran Songür M.Cem Koçkar Ahmet Akkaya

Öz

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

Anahtar Kelimeler

Akciðer tüberkülozu, akciðer dýþý organ tüberkülozu, sistemik lupus eritematozus

Kaynakça

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