title: Tuberculosis in immunosuppressed patients.
abstract: 11 patients who developed tuberculosis while on long-term immunosuppressive-drug therapy are described. The indications for immunosuppressive therapy were varied, but all patients received high doses of corticosteroids with azathioprine in addition in 2 cases and chlorambucil in a third. The diagnosis was delayed in all cases because of suppression of symptoms, so that 4 patients died, 3 directly as a result of tuberculosis. 3 of the remaining patients were critically ill at the time of diagnosis but recovered with antituberculosis chemotherapy; whereas the other 4, although not critically ill, had advanced cavitated pulmonary tuberculosis with miliary spread in one case. A clear policy of investigation and, if indicated, chemoprophylaxis is necessary for all patients in whom long-term immunosuppressive therapy, especially with prednisolone, is contemplated. A high index of suspicion for tuberculosis must be maintained with regular clinical and radiological review.
mesh_terms: D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects*; D002699:Chlorambucil / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D014390:Tuberculosis, Meningeal / Q000209:etiology; D014391:Tuberculosis, Miliary / Q000209:etiology; D014397:Tuberculosis, Pulmonary / Q000209:etiology
chemical_list: D002699:Chlorambucil; D011239:Prednisolone; D001379:Azathioprine