title: Treatment of systemic lupus erythematosus by immunoadsorption in a patient suffering from tuberculosis.
abstract: We report on a 40-year-old man, admitted with fever and weight loss, in whom systemic lupus erythematosus (lupus nephritis World Health Organization type IV) and concomitant acute lung tuberculosis were diagnosed. Conventional treatment of diffuse proliferative nephritis with cytotoxic drugs was thought to be too dangerous in the presence of active tuberculosis. A combination of immunoadsorption and steroids was instituted for the treatment of systemic lupus erythematosus. Antibodies against double-stranded DNA decreased, and proteinuria decreased from 10 g/24 hours to less than 1 g/24 hours. Tuberculosis was treated initially with quadruple-drug therapy, then a triple-drug protocol. Primarily enlarged lymph nodes decreased to normal size after 3 months. The combined treatment modality of steroids and immunoadsorption was effective and safe, even in this patient with active tuberculosis.
authors.affiliation: Department of Medicine I, Division of Infectious Diseases, University of Vienna, Vienna, Austria. sabine.schmaldienst@univie.ac.at
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmaldienst
authors.forename: Martin
authors.initials: M
authors.lastname: Jansen
authors.forename: Ursula
authors.initials: U
authors.lastname: Hollenstein
authors.forename: Winfried
authors.initials: W
authors.lastname: Graninger
authors.forename: Heinz
authors.initials: H
authors.lastname: Regele
authors.forename: Walter Hermann
authors.initials: WH
authors.lastname: Hörl
authors.forename: Kurt
authors.initials: K
authors.lastname: Derfler
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D007164:Immunosorbents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D011241:Prednisone / Q000008:administration & dosage*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D007164:Immunosorbents; D011241:Prednisone; D008775:Methylprednisolone