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Active tuberculosis in patients with systemic lupus erythematosus from Southern China: a retrospective study

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Abstract

To investigate the characteristics and associated factors for Mycobacterium tuberculosis (TB) infection in patients with systemic lupus erythematosus (SLE) from Southern China. A retrospective study of 1108 patients admitted to the First Affiliated Hospital of Sun Yat-Sen University from January 2007 to December 2017 was performed. Demographic and clinical characteristics, laboratory data, and radiographic manifestations were recorded. A total of 59 (5.3%) lupus patients with active TB were included. Pulmonary TB occurred in 41 (69.5%) patients. Single lobe involvement was showed in 14 (34.1%) patients. Multi-lobar involvement, including miliary TB (36.6%), was presented in 27 (65.8%) patients. Lower lobe involvement accounted for 31 (75.6%) of the cases. Extrapulmonary TB occurred in 18 (30.5%) patients. Nearly one-third (35.6%) of the patients developed disseminated TB. T-SPOT.TB assay was performed in 23 patients and positive in 18 patients (78.3%). Nineteen patients (32.2%) had co-infection with TB and other pathogens, most of which were bacterial-associated (52.6%). Lymphopenia was predominant in TB-infected patients, especially in those with disseminated TB. Multivariate logistic regression analysis found that lymphopenia [odds ratio (OR) = 2.19, 95% confidence interval (CI) 1.03–4.63, P = 0.04] and the accumulated doses of glucocorticoid (GC) (OR = 2.32, 95% CI 1.69–3.20, P < 0.001) were associated with TB. TB infection is a common comorbidity in patients with SLE. Manifestations of pulmonary computed tomography (CT) scan are relatively atypical. Co-infection with TB and other pathogens is not rare. Lymphopenia and the accumulated doses of GC are associated with TB infection in lupus patients.

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Funding

This project was supported by grants from the Guangdong Technology Project (2016A020215043) and grants from the National Natural Science Foundation of China (81603435, 81601403).

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Author notes

  1. Minxi Lao, Dongying Chen and Xiangni Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, the First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan Road 2, Guangzhou, 510080, Guangdong, China

    Minxi Lao, Dongying Chen, Qian Qiu, Xiuyan Yang & Zhongping Zhan

  2. Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Minxi Lao

  3. Department of Rheumatology, Beijing Jishuitan Hospital, Beijing, China

    Xiangni Wu

  4. Department of Respirology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Haihong Chen

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  1. Minxi Lao
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  4. Haihong Chen
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Correspondence to Zhongping Zhan.

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Ethics committee of the First Affiliated Hospital of Sun Yat-sen University approved the research. This work was conducted according to the provisions of the Declaration of Helsinki.

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Lao, M., Chen, D., Wu, X. et al. Active tuberculosis in patients with systemic lupus erythematosus from Southern China: a retrospective study. Clin Rheumatol 38, 535–543 (2019). https://doi.org/10.1007/s10067-018-4303-z

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  • DOI: https://doi.org/10.1007/s10067-018-4303-z

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