Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case-series.
OBJECTIVE
To describe the clinical characteristics of patients with systemic rheumatic diseases and tuberculosis. A retrospective case series from 1987 to 1994, drawn from a tertiary-care hospital in Mexico City, was studied.


RESULTS
Thirty patients were included (20 women, 10 men), with mean age of 39.8 years (range 14-66), and a mean duration of the systemic rheumatic disease of 44 months (1-372). The rheumatic diseases included systemic lupus erythematosus (SLE) (n = 13), rheumatoid arthritis (7), polymyositis or dermatomyositis (5), and other diseases (5). During the six months previous to the diagnosis of tuberculosis, 22 patients had received corticosteroids, and 13 others immunosuppressants. Mycobacterium tuberculosis was isolated from 18 patients. Pulmonary tuberculosis was found in 10 patients, and extrapulmonary tuberculosis in 20, seven of these with miliary disease. SLE was seen in 6 of the patients with miliary tuberculosis. The clinical manifestations were: fever (67%), weight loss (67%), diaphoresis (60%), cough and sputum (53%), lymph node enlargement (43%), and dyspnea (33%). Sixteen patients had an abnormal chest film. Of 18 patients tested by PPD RT-2, 8 had an induration > 10 mm. Patients were initially treated with 3 or 4 anti-tuberculosis drugs for 15 days to 6 months, followed by 6 to 10 months of isoniazid plus rifampicin. Three relapsed, and 2 died of respiratory failure.


CONCLUSIONS
This case series showed a particular pattern of tuberculosis in patients with systemic rheumatic diseases.
Department of Internal Medicine, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
B
B
Hernández-Cruz
J
J
Sifuentes-Osornio
S
S
Ponce-de-León Rosales
A
A
Ponce-de-León Garduño
E
E
Díaz-Jouanen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality
D000995:Antitubercular Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents