대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

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,