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Diagnostic challenge of tuberculosis in systemic lupus erythematosus: a case report and literature review

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Abstract

Patients with systemic lupus erythematosus (SLE) are at increased risk of tuberculosis (TB) infection due to immune dysfunction and immunosuppressive therapy. We present a case study of a 40-year-old woman with systemic lupus erythematosus (SLE). Initially, she was diagnosed with a lupus flare based on her clinical symptoms and laboratory results. However, upon further investigation, positive polymerase-chain reaction results for M. tuberculosis in the cerebrospinal fluid and lung parenchymal changes on chest computed tomography scan were indicative of TB infection. There was initial uncertainty regarding whether TB had triggered a flare-up of SLE or if TB was merely mimicking the symptoms of a SLE flare-up. However, as increasing the prednisolone dose did not have a positive effect and the patient’s condition improved significantly with anti-TB treatment alone, it became clearer that the deterioration observed upon admission was primarily due to TB progression rather than an SLE flare-up. Additionally, we review the current literature on TB and SLE, including risk factors, diagnostic challenges, and treatment considerations, highlighting the importance of considering TB infection in patients with SLE who present with overlap** manifestations. Prompt diagnosis and treatment are essential for improving outcomes in these patients.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this work.

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Authors and Affiliations

  1. 2nd Department of Internal Medicine, Ivan Horbachevsky Ternopil National Medical University, Majdan Voli, 1, Ternopil, 46001, Ukraine

    Svitlana Smiyan, Bohdan Koshak, Roman Komorovsky, Ulyana Slaba & Anastasia Bilukha

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  1. Svitlana Smiyan
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  2. Bohdan Koshak
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  3. Roman Komorovsky
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  4. Ulyana Slaba
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Contributions

SS and BK analyzed and interpreted the patient’s data, performed the review of literature and drafted the manuscript, RK contributed to conception and design of the work, contributed to drafting the manuscript and revised it critically for important intellectual content, US and AB analyzed the patient’s data and contributed to drafting the manuscript. All authors read and approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.

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Correspondence to Roman Komorovsky.

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Smiyan, S., Koshak, B., Komorovsky, R. et al. Diagnostic challenge of tuberculosis in systemic lupus erythematosus: a case report and literature review. Rheumatol Int 43, 2131–2139 (2023). https://doi.org/10.1007/s00296-023-05400-8

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