Abstract
We report the singular association of mediastinal pseudo-tumoral tuberculosis [TB] with systemic lupus erythematosus [SLE]. D. I, 22 years old woman, is followed for a SLE since 2006 controlled by hydrochloroquine ‘HCQ’200mg twice/day and a thyroiditis of Hashimoto under levothyrox 125 mg/d. It does not relate to tuberculosis. She is hospitalized in pneumology for progressive dyspnea and chest pain. Objective clinical examination shows a conserved general condition, apyrexia T° to 37, BMI to 21.1 (without notion of loss of weight), heart beat 94 / min, respiratory rate at 24 cycle/min and blood pressure at 110/60 mmHg. The pleuropulmonary and cardiovascular examination were without abnormality and thus the remainder of the clinical examination. The image of the thoracic face fails with a right para-cardiac opacity erasing the right edge of the cortex and the CT concludes to a mediastinal tumoral process, filling the gutter vertebral and extending from T6 to T10, with tissue density presenting areas of necrosis within it. Bronchial fibroscopy finds a thickening of inter-lobar spurs and bronchial biopsies identifies a bronchial mucosa site of chronic inflammatory remodeling with presence of multi-nucleated giant cells suggesting a tuberculoid process. The parameters of the hemogram were normal and the inflammatory syndrome was attested by both the increase ERS at 54 mm and the level of CRP at 12 mg/l. The smears, negative on direct examination, will prove positive for culture on Lowenstein medium. Antituberculosis treatment has been prescribed with good clinical, bacteriological and radiological progress. Long-term asymptomatic mediastinal pseudo-tumoral tuberculosis can be revealed at the compressive stage by dyspnea and chest pain. The fear of lymphoma requires biopsies with pathological examinations which sometimes reveal benign affections (tuberculosis, sarcoidosis in their tumor forms) which can enamel the autoimmune disorders characterizing a SLE.
Highlights
Systemic Lupus Erythematosus (SLE) is an autoimmune systemic disorder of unknown cause with various manifestations involving multiple organ systems
Antituberculosis treatment has been prescribed for 6 months – referring to the local recommendations- with good clinical, bacteriological and radiological progress (Figure 2) without any adverse effects referring to the clinical context
A less common cause is tuberculosis, a disease recognized for its atypical presentations attributed to its ability to affect almost any organ system[12] in this context. As it happened with SLE patients, the clinical suspicion of TB is hindered by several factors
Summary
Systemic Lupus Erythematosus (SLE) is an autoimmune systemic disorder of unknown cause with various manifestations involving multiple organ systems. Genetic factors include specific genes and chromosomal defects, and hormonal and environmental factors, such as vitamin D, are well-known immunomodulators of disease [1] [2]. Infections are the second leading cause of death in SLE patients (25%), immediately after the complications related to disease activity (26%) [3,4,5,6] and concerned most commonly tuberculosis with significant morbidity and mortality in endemic region, with more frequent and more extensive extra - pulmonary involvement [6,7,8,9,10]. International Journal of Cardiovascular and Thoracic Surgery 2017; 3(5): 63-66
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