First report of multi-drug resistant tuberculosis in a systemic lupus erythematosus patient Infectious Diseases

Kunchok Dorjee, Kerry L. Dierberg, Tsetan D. Sadutshang, Arthur L. Reingold

Research output: Contribution to journalArticle

Abstract

Abstract Background: Treatment of a multi-drug resistant tuberculosis (MDR-TB) patient is clinically challenging, requiring a minimum of 18 months of therapy. Its occurrence in a systemic lupus erythromatosus (SLE) patient may complicate management of both MDR-TB and SLE. This is the first descriptive report of MDR-TB in an SLE patient. Case presentation: A 19-year old female receiving long-term prednisolone for SLE was diagnosed with MDR-TB. She was started on MDR-TB treatment regimen and prednisolone was replaced with azathioprine. After an initial response to therapy, patient experienced a flare of lupus symptoms. Imaging studies revealed avascular necrosis of right femoral head. She was then treated with intravenous methyl-prednisolone, followed by maintenance corticosteroid. Azathioprine was discontinued due to hematological toxicity and failure to control SLE. Her symptoms of lupus regressed and did not re-occur for the duration of her MDR-TB treatment. Patient was declared cured of MDR-TB after 18 months of ATT. She is currently scheduled for a total hip replacement surgery. Conclusions: This case highlights the challenges of simultaneously managing MDR-TB and SLE in a patient due to their over-lapping signs and symptoms, drug-drug interactions, and the need for use of immunomodulatory agents in the absence of standard guidelines and documented previous experiences. Our experience underscores the importance of appropriate selection of treatment regimens for both MDR-TB and SLE.

Original languageEnglish (US)
Article number1302
Pages (from-to)1-4
Number of pages4
JournalBMC Research Notes
Volume8
Issue number1
DOIs
StatePublished - Aug 6 2015
Externally publishedYes

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Multidrug-Resistant Tuberculosis
Systemic Lupus Erythematosus
Communicable Diseases
Pharmaceutical Preparations
Prednisolone
Azathioprine
Therapeutics
Femur Head Necrosis
Drug interactions
Hip Replacement Arthroplasties
Lapping
Drug Interactions
Signs and Symptoms
Surgery
Adrenal Cortex Hormones
Toxicity
Maintenance
Guidelines
Imaging techniques

Keywords

  • Lupus
  • Multi-drug resistant tuberculosis
  • Systemic lupus erythematosus
  • Tuberculosis

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

First report of multi-drug resistant tuberculosis in a systemic lupus erythematosus patient Infectious Diseases. / Dorjee, Kunchok; Dierberg, Kerry L.; Sadutshang, Tsetan D.; Reingold, Arthur L.

In: BMC Research Notes, Vol. 8, No. 1, 1302, 06.08.2015, p. 1-4.

Research output: Contribution to journalArticle

Dorjee, Kunchok ; Dierberg, Kerry L. ; Sadutshang, Tsetan D. ; Reingold, Arthur L. / First report of multi-drug resistant tuberculosis in a systemic lupus erythematosus patient Infectious Diseases. In: BMC Research Notes. 2015 ; Vol. 8, No. 1. pp. 1-4.
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