Persistent sle activity related to untreated reactivation of pulmonary tuberculosis
نویسنده
چکیده
Methods WLS was diagnosed SLE at the age of 16 with fever, rash, oral ulcers, cytopenia, lupus nephritis (type II and III), retinal vasculitis and positive anti dsDNA. She was started on systemic steroid and Azathioprine. Symptoms became better and steroid was gradually tapered. However 3 months later she developed relapse of lupus activity with worsening lupus nephritis (active urinary sediments, heavy proteinuria up to 7.6g/day), cytopenia and high anti dsDNA titre. ESR was high but CRP was normal, a pattern commonly seen in active lupus. Azathioprine was switched to Mycophenolate Mofetil without much success. CXR was performed which showed prominent horizontal fissure of right lung. HRCT thorax scan, to our surprise, showed features of early TB reactivation. She had absolutely no respiratory symptom. Girl’s TST and CXR before commencement of steroid were negative. Gamma Interferon Releasing Assay (IGRA) was positive. Bronchoscopy finding was normal. Only the BAL of the RUL bronchus grew Mycobacterium Tuberculosis. Upon further questioning the parents recalled that the girl’s uncle died from pulmonary TB 4 years ago. She stayed with his family during a summer holiday 8 years ago. After commencing anti TB treatment, her SLE activity remitted with resolution of proteinuria and cytopenia, allowing steroid tapering.
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