Case report: Tuberculosis as a cause unilateral of sacroiliitis in lupus patients

Abstract

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease, with variable manifestations, which is frequently exacerbated, requiring differential diagnosis with infectious conditions. In the case report, the patient satisfied the following criteria as per ACR/EULAR (2019): FAN 1:640 homogeneous nuclear, fever, alopecia, hypocomplementemia, antidsDNA 1:80 and lymphopenia. She was on: prednisone 20mg/day, hydroxychloroquine 400mg/day and calcium+vitamin D3. She was pale (3/4+), dehydrated and tachycardic. Osteoarticular examination: Patrick-Fabere positive for left sacroiliac; pain in external and internal rotation in left hip and painful palpation in the metacarpal, proximal interphalangeal, wrists, knees, ankles, hip and thigh joints, especially in the left and right. Radiography showed extensive sclerosis (grades 3 and 4) in left sacroiliac and rectified lumbar lordosis. Later, magnetic resonance imaging revealed extensive subcortical bone marrow edema at the left sacroiliac associated with capsulitis. In addition to positive BAAR TRM-TB, Lupus patients present a high incidence of TB, which is an important hypothesis in febrile cases with inflammatory lombalgy, since its osteoarticular form mainly affects the spine. Therefore, the importance of differential diagnosis for effective management is evident.