Systemic Lupus Erithematosus (SLE) With Tuberculosis Lymphadenitis: A Case Report
Abstract
Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement and a heightened risk of infection due to immune dysregulation and immunosuppressive therapy. Tuberculosis (TB), particularly extrapulmonary forms like lymphadenitis, poses a significant threat to SLE patients, especially in TB-endemic regions.
Case Presentation: We report a case of a 22-year-old woman with a known history of SLE who presented with fever, persistent cough, and a progressively enlarging left cervical mass. The patient had been on immunosuppressive therapy, including methylprednisolone and cyclosporine. Physical examination and imaging revealed cervical lymphadenopathy, and fine needle aspiration biopsy (FNAB) confirmed TB lymphadenitis through the presence of acid-fast bacilli. GeneXpert testing of sputum further identified rifampicin-sensitive mycobacterium tuberculosis. The patient was treated with standard anti-tubercular therapy (2HRZE/4HR) while SLE management was continued with low-dose corticosteroids, folic acid, and calcium supplementation, guided by a SLEDAI-2K score of 0, indicating no active disease.
Outcome: Over a 6-month treatment period, the patient showed clinical improvement with resolution of the cervical mass, disappearance of respiratory symptoms, and weight gain. Laboratory parameters also improved, and no SLE flare was noted throughout TB treatment.
Conclusion: This case highlights the importance of early recognition and appropriate management of TB lymphadenitis in immunocompromised patients with SLE. FNAB remains a key diagnostic tool, and a multidisciplinary approach is critical to balancing anti-tuberculous therapy and autoimmune disease management without exacerbating either condition
Downloads
References
Aditama TY, dkk. Tuberkulosis Pedoman Diagnosis dan Penatalaksanaan di Indonesia, PERPARI, Jakarta, 2006. Arch Med Res 35:435–441
Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019;71(9):1400-1412. doi:10.1002/art.40930
Balbi, G. G. M., Machado-Ribeiro, F., Marques, C. D. L., Signorelli, F., & Levy, R. A. (2018). The interplay between tuberculosis and systemic lupus erythematosus. Current opinion in rheumatology, 30(4), 395–402. https://doi.org/10.1097/BOR.0000000000000493
Barber, M. R. W., Drenkard, C., Falasinnu, T., Hoi, A., Mak, A., Kow, N. Y., Svenungsson, E., Peterson, J., Clarke, A. E., & Ramsey-Goldman, R. (2021). Global epidemiology of systemic lupus erythematosus. Nature reviews. Rheumatology, 17(9), 515–532. https://doi.org/10.1038/s41584-021-00668-1
Erdozain JG, Ruiz-Irastorza G, Egurbide MV, Martinez-Berriotxoa A, Aguirre C. High risk of tuberculosis in systemic lupus erythematosus? Lupus. 2006;15:232–35.
Global tuberculosis report 2022. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Hamijoyo L, Sahiratmadja E, Ghassani NG, et al.: Tuberculosis Among Patients With Systemic Lupus Erythematosus in Indonesia: A Cohort Study. Open Forum. Infect. Dis. 2022 Jul 4; 9(7).
Hou CL, Tsai YC, Chen LC, Huang JL. Tuberculosis infection in patients with systemic lupus erythematosus: Pulmonary and extra-pulmonary infection compared. Clin Rheumatol. 2008;27:557–63.
Ilgazli A, Boyaci H, Basyigit I, Yildiz F (2004) Extrapulmonary
Justiz Vaillant AA, Goyal A, Varacallo M. Systemic Lupus Erythematosus. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535405/
Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015 Apr;78(2):47-55. doi: 10.4046/trd.2015.78.2.47. Epub 2015 Apr 2. PMID: 25861336; PMCID: PMC4388900.
Mathiasen, V.D. et al. (2019a) ‘Epidemiology of tuberculous lymphadenitis in Denmark: A nationwide register-based study’, PLOS ONE, 14(8). doi:10.1371/journal.pone.0221232.
Mok MY, Lo Y, Chan TM, Wong WS, Lau CS. Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy. J Rheumatol. 2005;32:609–15.
Patel, K. (2019) ‘A clinical study of tuberculous cervical lymphadenopathy: surgeon’s perspectives’, International Surgery Journal, 6(2), p. 581. doi:10.18203/2349-2902.isj20190407.
Pedoman Nasional Pelayanan Kedokteran. Tatalaksana Tuberkulosis. 2020. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/755/2019 Available at: https://tbindonesia.or.id/wp-content/uploads/2021/06/UMUM_PMK_No._67_ttg_Penanggulangan_Tuberkolosis_.pdf
Peto, H.M. et al. (2009) ‘Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993–2006’, Clinical Infectious Diseases, 49(9), pp. 1350–1357. doi:10.1086/605559.
Prabu, V., & Agrawal, S. (2010). Systemic lupus erythematosus and tuberculosis: a review of complex interactions of complicated diseases. Journal of postgraduate medicine, 56(3), 244–250. https://doi.org/10.4103/0022-3859.68653
Qasmi SA, Kiani F, Malik AI, et al.: Cervical Lymphadenopathy: A Common Diagnostic Dilemma.2012.
Sari IY, Kusmiati T: Primary Multidrug-Resistant Tuberculosis Mixed with Lymphadenitis Tuberculosis in a Woman with SLE. J. Respirasi. 2019 Apr 1; 1(3): 81
Silva J E, Silva C, Pacheco M, et al. (October 21, 2021) Simultaneous Systemic Lupus Erythematosus Flare and Disseminated Tuberculosis: Balancing Anti-Mycobacterial and Autoimmune Treatments. Cureus 13(10): e18944. doi:10.7759/cureus.18944 tuberculosis: clinical and epidemiologic spectrum of 636 cases.
Xiao, X. et al. (2020) ‘Tuberculosis in patients with systemic lupus erythematosus–a 37‐year longitudinal survey‐based study’, Journal of Internal Medicine, 290(1), pp. 101–115. doi:10.1111/joim.13218.
Zhang L, Wang DX, Ma L. A clinical study of tuberculosis infection in systemic lupus erythematosus. Zhonghua Nei Ke Za Zhi. 2008;7:808–10..
.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Slamet Wahyudi, Awalia
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
