title: Tuberculosis in SLE patients: rare diagnosis, risky treatment.
abstract: We document three cases of tuberculosis (TB) in 237 systemic lupus erythematosus (SLE) patients. Their ages at SLE and TB diagnoses were 13/15, 10/25, and 13/24 years. All were female and in all the TB was diagnosed during a period of lupus flare-up when they were receiving prednisolone and other immunosuppressive drugs. All three patients had extrapulmonary TB: Two had miliary TB and one had disseminated TB through the muscles, left knee joint, and lungs. All three patients experienced anti-TB drug-induced hepatotoxicity manifesting as jaundice along with elevated transaminase enzymes from the first-line anti-TB drugs they received, leading to a change to second-line drugs in two of them. In conclusion, although TB in SLE patients is not common, it should be considered when a patient is nonresponsive to the SLE treatment. Higher rates of extrapulmonary TB and anti-TB drug-induced hepatotoxicity in SLE patients with TB were noted.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Thailand.
authors.forename: Kanokpan
authors.initials: K
authors.lastname: Ruangnapa
authors.forename: Pornsak
authors.initials: P
authors.lastname: Dissaneewate
authors.forename: Prayong
authors.initials: P
authors.lastname: Vachvanichsanong
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology; D002648:Child; D005260:Female; D006801:Humans; D007565:Jaundice / Q000139:chemically induced; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D000637:Transaminases / Q000097:blood; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D000637:Transaminases
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