Clinical Rheumatology

, Volume 27, Issue 5, pp 557–563 | Cite as

Tuberculosis infection in patients with systemic lupus erythematosus: pulmonary and extra-pulmonary infection compared

  • Chih-Lung Hou
  • Yi-Chan Tsai
  • Li-Chen Chen
  • Jing-Long HuangEmail author
Original Article


Systemic lupus erythematosus (SLE) patients had an increased susceptibility to tuberculosis (TB). The aim of this study was to investigate the prevalence and clinical characteristics of TB in SLE patients, with focus on the differences between pulmonary and extra-pulmonary TB. This is a retrospective study that reviewed the medical records of 3,179 SLE patients from 1985 to 2004. The diagnosis of TB was confirmed by one of the following: positive acid-fast bacillus (AFB) smear, positive culture of Mycobacterium tuberculosis from appropriate specimens, or a histopathologic finding of caseating granuloma on specimen. During the 20-year review period, TB was documented in 19 SLE patients, with 21 episodes. Ten of 21 episodes (47.6%) were pulmonary TB while the other 11 episodes (52.4%) were extra-pulmonary TB. Among extra-pulmonary TB, there were joint and cutaneous involvements in five, miliary in two, Pott’s disease in two, peritoneum in one, and spleen in one. The most common manifestations of TB were fever and cough. Delayed diagnosis and adverse effects of anti-TB therapy were observed in the extra-pulmonary TB group. While SLE patients commonly present with prolonged fever or chronic cough, tuberculosis infection should be taken into consideration.


Extra-pulmonary tuberculosis Pulmonary tuberculosis Systemic lupus erythematosus 


  1. 1.
    Ward MM, Pyun E, Studenski S (1995) Causes of death in systemic lupus erythematosus. Long-term followup of an inception cohort. Arthritis Rheum 38:1492–1499PubMedCrossRefGoogle Scholar
  2. 2.
    Tsao CH, Chen CY, Ou LS, Huang JL (2002) Risk factors of mortality for salmonella infection in systemic lupus erythematosus. J Rheumatol 29:1214–1218PubMedGoogle Scholar
  3. 3.
    Hung JJ, Ou LS, Lee WI, Huang JL (2005) Central nervous system infections in patients with systemic lupus erythematosus. J Rheumatol 32:40–43PubMedGoogle Scholar
  4. 4.
    Wu KC, Yao TC, Yeh KW, Huang JL (2004) Osteomyelitis in patients with systemic lupus erythematosus. J Rheumatol 31:1340–1343PubMedGoogle Scholar
  5. 5.
    Sayarlioglu M, Inang M, Kamali S et al (2004) Tuberculosis in Turkish patients with systemic lupus erythematosus: increased frequency of extrapulmonary localization. Lupus 13:274–278PubMedCrossRefGoogle Scholar
  6. 6.
    Paton NI (1997) Infections in systemic lupus erythematosus patients. Ann Acad Med Singapore 26:694–700PubMedGoogle Scholar
  7. 7.
    Tam LS, Li EK, Wong SM, Szeto CC (2002) Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong. Scand J Rheumatol 31:296–300PubMedCrossRefGoogle Scholar
  8. 8.
    Balakrishnan C, Mangat G, Mittal G, Joshi VR (1998) Tuberculosis in patients with systemic lupus erythematosus. J Assoc Physicians India 46:682–683PubMedGoogle Scholar
  9. 9.
    Feng PH, Tan TH (1982) Tuberculosis in patients with systemic lupus erythematosus. Ann Rheum Dis 41:11–14PubMedCrossRefGoogle Scholar
  10. 10.
    Victorio-Navarra ST, Dy EE, Arroyo CG, Torralba TP (1996) Tuberculosis among Filipino patients with systemic lupus erythematosus. Semin Arthritis Rheum 26:628–634PubMedCrossRefGoogle Scholar
  11. 11.
    Pryor BD, Bologna SG, Kahl LE (1996) Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus. Arthritis Rheum 39:1475–1482PubMedCrossRefGoogle Scholar
  12. 12.
    Noel V, Lortholary O, Casassus P et al (2001) Risk factors and prognostic influence of infection in a single cohort of 87 adults with systemic lupus erythematosus. Ann Rheum Dis 60:1141–1144PubMedCrossRefGoogle Scholar
  13. 13.
    Paton NI, Cheong IK, Kong NC, Segasothy M (1996) Risk factors for infection in Malaysian patients with systemic lupus erythematosus. QJM 89:531–538PubMedGoogle Scholar
  14. 14.
    Hernandez-Cruz B, Sifuentes-Osornio J, Ponce-de-Leon RS, Ponce-de-Leon GA, Diaz-Jouanen E (1999) Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case-series. Clin Exp Rheumatol 17:289–296Google Scholar
  15. 15.
    Tan EM, Cohen AS, Fries JF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277PubMedCrossRefGoogle Scholar
  16. 16.
    Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35:630–640PubMedCrossRefGoogle Scholar
  17. 17.
    Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C (2003) Tuberculosis. Lancet 362:887–899PubMedCrossRefGoogle Scholar
  18. 18.
    Corett EL, Watt CJ, Walker N et al (2003) The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 163:1009–10021CrossRefGoogle Scholar
  19. 19.
    de Luis A, Pigrau C, Pahissa A, Fernandez F, Matinez-Vazquez JM (1990) Infections in 96 cases of systemic lupus erythematosus. Med Clin (Barc) 94:607–610Google Scholar
  20. 20.
    Gaitinde S, Pathan E, Sule A, Mittal G, Joshi VR (2002) Efficacy of isoniazid prophylaxis in patients with systemic lupus erythematosus receiving long term steroid treatment. Ann Rheum Dis 61:251–253CrossRefGoogle Scholar
  21. 21.
    Huang JL, Lin CJ, Hung IJ, Luo SF (1994) The morbidity and mortality associated with childhood onset systemic lupus erythematosus. Chang Gung Med J 17:113–120Google Scholar
  22. 22.
    Dessein PH, Gledhill RF, Rossouw DS (1988) Systemic lupus erythematosus in black South Africans. S Afr Med J 74:387–389PubMedGoogle Scholar
  23. 23.
    Rovensky J, Kovalancik M, Kristufek P et al (1996) Contribution to the problem of occurrence of tuberculosis in patients with systemic lupus erythematosus. Z Rheumatol 55:180–187PubMedGoogle Scholar
  24. 24.
    Yun JE, Lee SW, Kim TH et al (2002) The incidence and clinical characteristics of Mycobacterium tuberculosis infection among systemic lupus erythematosus and rheumatoid arthritis patients in Korea. Clin Exp Rheumatol 20:127–132PubMedGoogle Scholar
  25. 25.
    Small PM, Fujiwara RA PI (2001) Management of tuberculosis in the United States. N Engl J Med 345:189–200PubMedCrossRefGoogle Scholar
  26. 26.
    Ilgazli A, Boyaci H, Basyigit I, Yildiz F (2004) Extrapulmonary tuberculosis: clinical and epidemiologic spectrum of 636 cases. Arch Med Res 35:435–441PubMedCrossRefGoogle Scholar
  27. 27.
    Division of Tuberculosis Control, BC Centre for Disease Control (1998) Annual Report. Vancouver, B.C., Canada: Centre for Disease ControlGoogle Scholar
  28. 28.
    Le Moing V, Leport C (1998) Infections and lupus. Rev Prat 48:637–642PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  • Chih-Lung Hou
    • 1
    • 2
    • 3
  • Yi-Chan Tsai
    • 1
    • 2
    • 3
  • Li-Chen Chen
    • 1
    • 2
    • 3
  • Jing-Long Huang
    • 1
    • 2
    • 3
    Email author
  1. 1.Division of Allergy, Asthma and Rheumatology, Department of PediatricsChang Gung Memorial HospitalTaoyuanTaiwan
  2. 2.Division of Allergy, Asthma and Rheumatology, Department of PediatricsChang Gung Children’s HospitalTaoyuanTaiwan
  3. 3.Division of Allergy, Asthma and Rheumatology, Department of PediatricsChang Gung UniversityTaoyuanTaiwan

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