Diagnosis of TB Granuloma in SLE Patient by Kidney Biopsy

Abstract

Lupus Nephritis is a common clinical manifestation affecting more than 50% of patients with Systemic Lupus Erythematosus (SLE), a chronic autoimmune disease that can affect virtually any organ. Whilst lupus nephritis is typically detected by an abnormal urinalysis with or without an elevated plasma creatinine, diagnosis is confirmed on renal biopsy. It is characterized by immunologic abnormalities including formation of immunocomplex deposits affecting the glomerular basement membrane, mesangium and/or subendothelial. It is by nature an immunocompromised state and along with its immunosuppressive treatment, lupus nephritis places a patient at high risk of opportunistic infections, including Tuberculosis (TB). A 21-year-old female presented with clinical features suggestive of lupus nephritis and a preserved renal function. The diagnosis was later confirmed on renal biopsy with an incidental finding of TB on renal histopathology. Interestingly, the patient had no constitutional symptoms or clinical history suggestive of TB. Antituberculosis treatment was initiated and mycophenolate, enalapril and prednisone was boarded after 2 weeks of TB treatment. The patient was later lost to follow up due to defaulting chronic treatment and follow up.