Rheumatology International

, Volume 29, Issue 9, pp 1047–1050 | Cite as

Mycobacterium tuberculosis infection precipitates SLE in patients from endemic areas

  • Kanjaksha Ghosh
  • Manisha Patwardhan
  • Vandana Pradhan
Original Article


In a cohort of 70 systemic lupus erythematosus (SLE) patients diagnosed over 2 years period, 14 patients were found to have confirmed antecedent tuberculosis (20.0%) which was 40 times higher (p < 0.001, 95%CI 36.2–48.6) than the prevalence of tuberculosis in the local population. Demonstration of anti-histone antibodies in similar proportion of SLE patients with and without antecedent anti-TB treatment and similar proportion of renal involvement (36 vs. 40%) between anti-TB drug exposed and non-exposed patients ruled out the drugs to be causative factors in precipitating SLE in these patients with antecedent history of tuberculosis. A cohort of 30 confirmed pulmonary tuberculosis patients were also studied in parallel to demonstrate high incidence of autoantibodies in these patients but no SLE. This study suggests a role of prior tuberculosis in precipitating SLE in genetically predisposed patients.


SLE M. tuberculosis Autoimmunity Endemic area Drug induced SLE 


  1. 1.
    Erdozain JG, Ruiz-Irastroza G, Ebubride MV, Mantinez-Berrriot Xoa A (2006) Aguirrec, high risk of tuberculosis in systemic lupus erythematosus? Lupus 15:232–235. doi:10.1191/0961203306lu2289xx Google Scholar
  2. 2.
    Sayarlioglu M, Inanc M, Kamali S, Cefle A, Karamen O, Gul A et al (2004) Tuberculosis in Turkish patients with systemic lupus erythematosus: increased frequency of extrapulmonary localisation. Lupus 13:274–278. doi:10.1191/0961203303lu529xx PubMedCrossRefGoogle Scholar
  3. 3.
    Balakrishnan C, Hangat G, Mittal G, Joshi VR (1998) Tuberculosis in patients with systemic lupus erythematosus. J Assoc Phys Ind 46:682–683Google Scholar
  4. 4.
    Yun JE, Lee SW, Kim TH, Jun JB, Jung S, Bae SC, Kim TY, Yoo DH (2002) The incidence and clinical characteristics of tuberculosis infection among systemic lupus erythematosus and Rheumatoid arthritis patients in Korea. Clin Exp Rheumatol 20:127–132PubMedGoogle Scholar
  5. 5.
    Lamm DL, Blumenstein BA, Crowford ED, Montie JE, Scardino P, Grossman HB et al (1991) A randomized trial of intravesical doxorubicin and immunotherapy with Bacille Calmette-Guerin for transitional cell carcinoma of the bladder. N Engl J Med 352:1205–1209CrossRefGoogle Scholar
  6. 6.
    Krone B, Kolmel KF, Henz BM, Wange JM (2005) Protection against melanoma by vaccination of Bacille Calmette guerin (BCG) and/or vaccinia: an epidemiology based hypothesis on the nature of melanoma risk factor and its immunological control. Eur J Cancer 41:104–117. doi:10.1016/j.ejca.2004.08.010 PubMedCrossRefGoogle Scholar
  7. 7.
    Burling F, Ng J, Thein H, Ly J, Marshall MR, Gow P (2007) Ethnic, clinical and immunological factors in systemic lupus erythematosus and the development of lupus nephritis: results from a multiethnic New Zealand cohort. Lupus 16:830–837. doi:10.1177/0961203307080225 PubMedCrossRefGoogle Scholar
  8. 8.
    Burlingame RW, Rubin RL (1991) Drug induced autoantibodies display two patterns of reactivity with substructures of chromatin. J Clin Invest 88:680–690. doi:10.1172/JCI115353 PubMedCrossRefGoogle Scholar
  9. 9.
    Holoshitz J, Hatitisk A, Cohen IR (1984) Arthritis induced in rats by cloned T lymphocytes responsive to mycobacteria but not to collagen type II. J Clin Invest 73:211–215. doi:10.1172/JCI111193 PubMedCrossRefGoogle Scholar
  10. 10.
    Van Eden U, Holoshitz J, Nevo Z, Frenkel A, Klugman A, Cohen IR (1985) Arthritis induced by a T lymphocyte clone that responds to mycobacterium tuberculosis and to cartilage proteoglycans. Proc Natl Acad Sci USA 82:5117–5120. doi:10.1073/pnas.82.15.5117 PubMedCrossRefGoogle Scholar
  11. 11.
    Thomson SJ, Butcher PD, Patel VK, Rook GA, Stanford J, Van der Zee R et al (1991) Modulation of pristine induced arthritis by mycobacterial antigens. Autoimmunity 11:35–43. doi:10.3109/08916939108994706 CrossRefGoogle Scholar
  12. 12.
    Pradhan VD, Badakere SS, Ghosh K, Pawar A (2004) Spectrum of anti-neutrophil cytoplasmic antibodies in patients with pulmonart tuberculosis overlaps with that of Wegener’s Granulomatous. Int J Med Sci 58:283–288Google Scholar
  13. 13.
    Shoenfield Y, Isanborg DA (1988) Mycobacterium and autoimmunity. Immunol Today 9:178–182. doi:10.1016/0167-5699(88)91294-7 CrossRefGoogle Scholar
  14. 14.
    Shoenfield Y, Schwatz RS (1984) Immunologic and genetic factors in autoimmune diseases. N Engl J Med 311:1019–1029Google Scholar
  15. 15.
    Shoenfoeld Y, Vilner Y, Coates ARM, Ranch J, Lavie G, Shaul D et al (1986) Monoclonal antituberculosis antibodies react with DNA and monoclonal anti-DNA autoantibodies react with Mycobacterium tuberculosis. Clin Exp Immunol 66:255–261Google Scholar
  16. 16.
    Purice S, Mitu S, Popescu T, Guran M, Vintila M, Suta G (1982) The relationship between systemic lupus erythematosus and tuberculosis. Med Interne 20:191–196PubMedGoogle Scholar
  17. 17.
    Correa PA, Gomez LM, Cadena J, Anaya JM (2005) Autoimmunity and tuberculosis. Opposite association with TNF polymorphism. J Rheumatol 32:219–225PubMedGoogle Scholar
  18. 18.
    Sanger C, Busche A, Bentien G, Spallek R, Jonas F, Bohle A et al (2004) Immunodominant Pst S1 antigen of Mycobacterium tuberculosis is a potent biological response modifier for the treatment of bladder cancer. BMC Cancer 4:86. doi:10.1186/1471-2407-4-86 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Kanjaksha Ghosh
    • 1
  • Manisha Patwardhan
    • 1
  • Vandana Pradhan
    • 1
  1. 1.Department of Immunology and AutoimmunedisordersNational Institute of Immunohaematology (ICMR)MumbaiIndia

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