Localization of extrapulmonary tuberculosis in the synovial membrane, skin, and meninges in a patient with systemic lupus erythematosus and IgG deficiency.
We report on a 31-year-old female patient with systemic lupus erythematosus (SLE) for 24 years who had a past history of skin tuberculosis (lupus vulgaris), long-term corticosteroid therapy, and IgG deficiency. She presented with monoarthritis and concomitant meningitis from skin tuberculosis after 5 years. The diagnosis of joint and meningeal tuberculosis was defined with clinical symptoms--signs and typical histopathological findings of involved synovium. Clinical improvement was achieved with antituberculous therapy. Cutaneous, articular, and cerebral manifestations of tuberculosis might have been confused with some of the lupus manifestations or lupus activation. It should be kept in mind that tuberculosis may be encountered in SLE due to the nature of the underlying disease and/or its therapy. It is also worth mentioning that, in this patient, tissues involved with extrapulmonary tuberculosis were the primary areas of involvement with SLE.
Düzgün
Nursen
N
Dept of Clinical Immunology and Rheumatology, Ankara University, School of Medicine, Turkey. duzgun@medicine.ankara.edu.tr
Peksari
Yavuz
Y
Sonel
Birkan
B
Yücesan
Canan
C
Erekul
Selim
S
Duman
Murat
M
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D017099:IgG Deficiency / Q000139:chemically induced / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity; D012867:Skin / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D013583:Synovial Membrane / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome; D014382:Tuberculosis, Cutaneous / Q000139:chemically induced / Q000276:immunology*; D014390:Tuberculosis, Meningeal / Q000139:chemically induced / Q000276:immunology*; D014394:Tuberculosis, Osteoarticular / Q000139:chemically induced / Q000276:immunology*
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents