title: Exacerbation of latent lupus: is the culprit acid-fast bacilli or antitubercular therapy?
abstract: Typical as well as atypical presentations of systemic lupus erythematosus are being increasingly recognized due to improved diagnostic methods. In a tuberculosis-endemic country like India, it was traditionally believed that the occurrence of tuberculosis in lupus was due to the chronic immunosuppression caused by lupus or because of the use of steroids or isoniazid-induced lupus. Increasingly several patients with no recorded predisposition to lupus with a history of treatment for tuberculosis are coming with evidence of systemic lupus erythematosus rather than a drug-limited story. Whether the development of an autoimmune state is a mere conjecture or the presence of acid-fast bacilli in the body for a prolonged duration causes complex antigenic interactions leading to an antigenic response needs to be looked into. We present a report of three such patients and review the pathogenetic interactions that could possibly explain the role of mycobacterial antigens as a putative antigen in the pathogenesis of lupus.
authors.affiliation: Department of Medicine, Pt. B. D Sharma PGIMS, Rohtak, Haryana, India. drhps1@rediffmail.com
authors.forename: Harpreet
authors.initials: H
authors.lastname: Singh
authors.forename: Sucharita
authors.initials: S
authors.lastname: Ray
authors.forename: Maneet
authors.initials: M
authors.lastname: Kaur
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Harish
authors.initials: H
authors.lastname: Kumar
authors.forename: Paulomi
authors.initials: P
authors.lastname: Talapatra
authors.forename: Rekha
authors.initials: R
authors.lastname: Mathur
authors.forename: Suvrat
authors.initials: S
authors.lastname: Arya
authors.forename: Naveen
authors.initials: N
authors.lastname: Ghangas
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000009:adverse effects*; D015551:Autoimmunity; D000939:Epitopes / Q000276:immunology; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D007538:Isoniazid / Q000009:adverse effects; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology*; D009169:Mycobacterium tuberculosis; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D000939:Epitopes; D007166:Immunosuppressive Agents; D007538:Isoniazid