CONCLUSIONSLE and APS may present with thrombocytopenia, but in both cases, a good response to treatment with corticosteroids and immunosuppressants would be expected, which did not occur with the patient mentioned in the case. Thrombocytopenia in cirrhosis liver is usually primarily due to decreased hepatic production of thrombopoietin rather than splenic sequestration. However, this was also not observed in the present case as platelets reached normal levels after splenectomy. Therefore, thrombocytopenia was due to splenic sequestration, resulting from cirrhosis.

BACKGROUNDInfection can be a threat to systemic lupus erythematosus (SLE) patients who have compromised immune system, being considered one of the most common causes of mortality in SLE, both by immunological factors of the disease itself or by suppressive treatment. Tuberculosis (TB) has a prevalence of 5 to 30% in patients with SLE, mainly in the extrapulmonary forms with more extensive pulmonary involvement, and a higher relapse rate. The aim of this study is to report cases of patients with SLE and TB infection treated in a tertiary hospital. METHODSThis retrospective study included cases of SLE and concomitant pulmonary, extrapulmonary and disseminated TB infection. Patient data was processed to extract information such as age, sex, time of illness, disease activity, and immunosuppressive treatment. RESULTSThe observed result showed a total of 28 patients, of which 26 received confirmation of the bacteriological diagnosis by Molecular Rapid Test for TB (MRT-TB) or smear microscopy during the investigation of the underlying disease activity. Two patients received empirical diagnosis due to highly suggestive clinical manifestation. The mean age of patients was 28.3 years. The female:male ratio in this sample was 27:1. The mean time of lupus diagnosis was 5.19 years and the main disease activity was 67% renal involvement. The other underlying disease activity was hematological, serositis, neurological and interstitial lung disease. It could be seen in the medical records that urinary and pulmonary TB was the most frequent infection in these patients, seven cases each. The second prevalent territory was TB in the central nervous system in six patients, followed by pleural and peritoneal TB, with four and three patients, respectively. There was also a diagnosis of joint, pericardial and intestinal TB. It was observed in the medical records that five patients were diagnosed with disseminated TB, presenting positive MRT-TB in two or more territories. All 28 patients were receiving corticosteroids; six of them had recent pulse therapy with methylprednisolone; six of them receiving mycophenolate mofetil; two patients receiving azathioprine; one patient was receiving cyclophosphamide and the other rituximab. CONCLUSIONTB remains a public health problem in Brazil. A clinical distinction between infection and lupus flare-up is required when patients with SLE present fevers or other infection symptom. Diagnosis should be suspected in patients investigating disease activity or in use of high-dose glucocorticoids and immunosuppressant, although differentiating between infection and disease activity is a dilemma in SLE.

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