First report of multi-drug resistant tuberculosis in a systemic lupus erythematosus patient

BMC Research Notes

Arthur L Reingold²  Tsetan D Sadutshang¹  Kerry L Dierberg³  Kunchok Dorjee¹ 

[1] The Tibetan Delek Hospital, Dharamshala, Himachal Pradesh, India;Division of Epidemiology, School of Public Health, University of California, Berkeley, 113 Haviland Hall #7358, Berkeley 94720-7358, CA, USA;Johns Hopkins University School of Medicine, Baltimore, MD, USA

关键词: Lupus;    Systemic lupus erythematosus;    Multi-drug resistant tuberculosis;    Tuberculosis;   

Others  :  1230899
DOI  :  10.1186/s13104-015-1302-x

 received in 2015-05-12, accepted in 2015-07-27,  发布年份 2015

【 摘 要 】

Background

Treatment of a multi-drug resistant tuberculosis (MDR-TB) patient is clinically challenging, requiring a minimum of 18 months of therapy. Its occurrence in a systemic lupus erythromatosus (SLE) patient may complicate management of both MDR-TB and SLE. This is the first descriptive report of MDR-TB in an SLE patient.

Case presentation

A 19-year old female receiving long-term prednisolone for SLE was diagnosed with MDR-TB. She was started on MDR-TB treatment regimen and prednisolone was replaced with azathioprine. After an initial response to therapy, patient experienced a flare of lupus symptoms. Imaging studies revealed avascular necrosis of right femoral head. She was then treated with intravenous methyl-prednisolone, followed by maintenance corticosteroid. Azathioprine was discontinued due to hematological toxicity and failure to control SLE. Her symptoms of lupus regressed and did not re-occur for the duration of her MDR-TB treatment. Patient was declared cured of MDR-TB after 18 months of ATT. She is currently scheduled for a total hip replacement surgery.

Conclusions

This case highlights the challenges of simultaneously managing MDR-TB and SLE in a patient due to their over-lapping signs and symptoms, drug–drug interactions, and the need for use of immunomodulatory agents in the absence of standard guidelines and documented previous experiences. Our experience underscores the importance of appropriate selection of treatment regimens for both MDR-TB and SLE.

【 授权许可】

   
2015 Dorjee et al.

【 图 表 】

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