ab17_3

Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case-series

B. Hernández-Cruz¹, J. Sifuentes-Osornio², S. Ponce-de-León Rosales¹, A. Ponce-de-León Garduño², E. Díaz-Jouanen³

Department of Internal Medicine¹, Department of Infectious Diseases², and Teaching Division³, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.

ABSTRACT
Objective
To describe the clinical characteristics of patients with systemic rheumatic diseases and tuberculosis. A retrospective case series from 1987 to 1994, drawn from a tertiary-care hospital in Mexico City, was studied.

Results
Thirty patients were included (20 women, 10 men), with mean age of 39.8 years (range 14 - 66), and a mean duration of the systemic rheumatic disease of 44 months (1 - 372). The rheumatic diseases included systemic lupus erythematosus (SLE) (n = 13), rheumatoid arthritis (7), polymyositis or dermatomyositis (5), and other diseases (5). During the six months previous to the diagnosis of tuberculosis, 22 patients had received corticosteroids, and 13 others immunosuppressants. Mycobacterium tuberculosis was isolated from 18 patients. Pulmonary tuberculosis was found in 10 patients, and extra-pulmonary tuberculosis in 20, seven of these with miliary disease. SLE was seen in 6 of the patients with miliary tuberculosis. The clinical manifestations were: fever (67%), weight loss (67%), diaphoresis (60%), cough and sputum (53%), lymph node enlargement (43%), and dyspnea (33%). Sixteen patients had an abnormal chest film. Of 18 patients tested by PPD RT-2, 8 had an induration > 10 mm. Patients were initially treated with 3 or 4 anti-tuberculosis drugs for 15 days to 6 months, followed by 6 to 10 months of isoniazid plus rifampicin. Three relapsed, and 2 died of respiratory failure.

Conclusions
This case series showed a particular pattern of tuberculosis in patients with systemic rheumatic diseases.

Key words
Tuberculosis, systemic lupus erythematosus, systemic rheumatic diseases, developing countries.

Please address correspondence and reprint requests to: Efraín Díaz-Jouanen, MD, Teaching Division, Instituto Nacional de la Nutrición Salvador Zubirán. Vasco de Quiroga 15, México, D.F. 14000, Mexico.