Weekly Chest CasesArchive of Old Cases

Case No : 184 Date 2001-05-05

  • Courtesy of Kun-il im, M.D. / Pusan National University Hospital, Pusan, Korea
  • Age/Sex 53 / F
  • Chief ComplaintChilling, dyspnea for 3 weeks She has been medicated with corticosteroid due to Systemic Lupus Erythematosus.
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Diagnosis With Brief Discussion

Diagnosis
Pulmonary Tuberculosis in a Patient with SLE
Radiologic Findings
Chest radiographs shows diffuse multifocal patchy opacities and nodular opacities in both lungs without zonal predominance. Chest radiograph obtained 3 days later showed extensive consolidations in both lungs, suggesting progression into acute respiratory distress syndrome (not shown). High-resolution CT scan reveals multifocal patchy consolidations with halo of GGO, centrilobular nodules, miliary nodules, and interlobular septal thickenings in both lungs. AFB was identified at sputum examination.
Brief Review
Pulmonary tuberculosis in patients with SLE may manifest differently from that in immunocompetent patients and may have higher incidence(5-8.8%) because of abnormal function of alveolar macrophages and exposure to corticosteroid and cytotoxic drugs. Because systemic symptoms may be masked in patients undergoing immunosuppressive therapy, delay in diagnosis of tuberculosis may contribute to a relatively high incidence of both miliary and extrapulmonary tuberculosis and to high mortality.

Radiologic findings in patients with SLE who are taking steroids can be those seen in secondary tuberculosis, those for primary tuberculosis or miliary tuberculosis. Some patients shows atypical opacities with bilateral or unilateral diffuse patchy consolidations that could not be categorized into secondary, miliary, or primary tuberculosis. High-resolution CT depicted pattern of miliary tuberculosis, centrilobular nodules, lobar or segmental consolidations and diffuse patchy consolidations throughout the lung. Cavitary nodules are rare in patients with SLE.
References
1. Kim HY, Im JG. Pulmonary tuberculosis in Patients with SLE. AJR 1999;173:1639-1642
2. Davis SD. Pulmonary tuberculosis in immunocompromised hosts: epidemiological, clinical, and radiological assessment. Semin Roentgenol 1993;28:119-130
Keywords
Lung, Infection, Bacterial infection, immune related, tuberculosis,

No. of Applicants : 20

▶ Correct Answer : 15/20,  75.0%
  • - 媛• 理œ
  • - 怨
  • - 怨
  • - 怨
  • -
  • - 源€
  • - 諛•
  • -
  • -
  • - 源€
  • -
  • - CHU Nancy-Brabois, France Denis Regent
  • - Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
  • - Seoul National University Hospital Tae Jung Kim
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
▶ Semi-Correct Answer : 2/20,  10.0%
  • - 嫄닿뎅
  • - Ospedale di Fabriano, Italy Giancarlo Passarini
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