Objectives To investigate the frequency and characteristics of tuberculosis (TB) in patients with systemic lupus erythematosus (SLE).
Methods We reviewed the charts of 556 patients with SLE who were followed-up between 1978–2001 in our lupus clinic. Sixteen patients who developed tuberculosis after the diagnosis of SLE were identified and included into the study. Clinical characteristics of patients recorded according to a predefined protocol.
Results Demographic characteristics of patients were as follows: Male/female ratio:3/13, age at disease onset: 32.7 ± 9.1 (23–52), median follow-up time: 83 ± 75 months (3–260), mean time elapsed from the diagnosis of SLE to onset of TB: 54 ± 50 months (2–174), mean duration of follow-up after the diagnosis of TB: 47 ± 43 months (6–163). Diagnosis of TB was confirmed microbiologically in 68% of patients. Eight of 16 patients (50%) had extrapulmonary TB (vertebral involvement in 3, meningeal in 2 and skin and soft tissue in 3). All patients had been treated with prednisolon (PRD) (cumulative dose of; 19.7 ± 16.2 g) before the diagnosis of TB. Seven of 16 (44%) patients were additionally treated with pulse PRD, 6 of 16 (38%) with cyclophosphamide and 1 of 16 (0.6%) with azathioprine.
Conclusion TB infection occurred in 2.9% of patients with SLE in the early or late period after the diagnosis and initiation of immunosuppresive treatment. Extrapulmonary localization of TB was strikingly more than expected and a search for TB should be undertaken in SLE patients who developed novel neurological, musculoskeletal, skin and soft tissue manifestations. The precise role of immunosuppresive regimes and the place of prophylaxis in the development of TB in SLE remain to be determined.
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