Disseminated tuberculosis in adolescent systemic lupus erythematosus after negative baseline screening: a case report
Abstract
Abstract Background Patients with systemic lupus erythematosus (SLE) are at increased risk of tuberculosis (TB) because of disease-related immune dysregulation and prolonged immunosuppressive therapy. Screening for latent TB infection (LTBI) before initiating immunosuppression is recommended, although both the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) may yield false-negative results in immunocompromised individuals. Case presentation A 15-year-old girl with SLE complicated by lupus nephritis presented with fever, progressive dyspnoea, and abdominal pain after approximately eight months of corticosteroid and mycophenolate mofetil (MMF) therapy. Baseline TB screening before immunosuppressive treatment consisted of chest radiography and TST, with a TST induration of 0 mm. IGRA was not performed. During admission, chest radiography demonstrated diffuse miliary nodules with pleural effusion. Laboratory examination showed pancytopenia and markedly elevated transaminases. Repeat TST showed 15 mm induration. GeneXpert MTB/RIF detected rifampicin-susceptible Mycobacterium tuberculosis in sputum, stool, and urine specimens, confirming disseminated TB involving pulmonary, abdominal, and genitourinary systems. Because of severe transaminase elevation, hepatotoxic first-line anti-TB agents were initially deferred, and treatment was started with levofloxacin and ethambutol. Conclusion This case demonstrates that negative baseline TST does not exclude LTBI or…
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