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Vol. 15. Issue 4.
Pages 721-727 (July - August 2009)
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Vol. 15. Issue 4.
Pages 721-727 (July - August 2009)
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Serosite tuberculosa em portadora de lúpus eritematoso sistémico – Relato de caso e revisão de literatura
Tuberculous serositis in patient with systemic lupus erythematosus – Case report and literature review
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João Cláudio Barroso Pereira1,a, Althair de Araújo Silva Sr.ª2, Roberto Silveira Dr.3
1 Médico Tisiologista do Serviço de Atendimento Especializado da SMS-Belford Roxo, Médico do CRA-DIP do Hospital Municipal Nelson de SÁ Earp e do Programa de Controle da Tuberculose da SMS-Petrópolis – Rio de Janeiro Brasil
2 Administradora do Serviço de Atendimento Especializado, Belford Roxo – Rio de Janeiro
3 Director do Hospital Municipal Nelson de Sá Earp, Petrópolis – Rio de Janeiro
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Resumo

Trata-se de um relato de caso de uma doente jovem que preencheu critérios para diagnóstico de LES, segundo a Associação Americana de Reumatologia. A doente apresentava febre, anemia, artrite, cilindrúria, positividade para células LE e presença de anticorpos antinuclear. Ela evoluiu com derrame pleural bilateral e derrame pericárdico que ambos, inicialmente, foram atribuídos ao lúpus. Visto que manteve febre baixa, sudorese, emagrecimento e persistência da serosite, foi submetida a toracocentese que revelou pleurite crónica granulomatosa, diagnosticando tuberculose. Uma pericardiocentese foi realizada. Após início da terapia com fármacos antituberculosos, houve regressão do quadro de serosite. São discutidos alguns conceitos relacionados com ambas as doenças, como os sintomas, os diagnósticos e as situações pertinentes tanto ao lúpus como à tuberculose. É ressaltada a necessidade de um diagnóstico e tratamento da tuberculose doença nos portadores de lúpus, o mais precoce possível, principalmente em áreas endémicas para a tuberculose.

Palavras-chaves:
Serosite
lúpus eritematoso sistémico
tuberculose extrapulmonar
Abstract

It is a case report of young female that had diagnostic criteria of Systemic Lupus Erithematosus in activity, according American Rheumatology Association. The patient had fever, anemia, arthritis, cellular casts, positive LE cells, positive antinuclear antibody. She has evolved to bilateral pleural effusion and pericardic effusion that both have been initially attributed to lupus. Due to she has also maintained low fever, sudoresis, loss of weight and a persistent serositis, a thoracocenthesis with pleural biopsy has been done and the result of it has revealed granulomatous chronic pleuritis, diagnosticing pleural tuberculosis. A pericardiocenthesis has also been done. After six months of anti-tuberculosis therapy, there was a regression of radiologic imaging. Some concepts referring to tuberculosis and systemic lupus erythematosus are discussed, including symptons, diagnosis and specific situations. It is emphasized the necessity of early diagnosis and appropriate management of tuberculosis disease in lupic patients, in areas where tuberculosis is endemic.

Key-words:
Serositis
systemic lupus erythematosus
extra-pulmonary tuberculosis
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Tema apresentado sob forma de caso clínico, através de posters, durante o XXII Congresso de Pneumologia e IV Congresso Luso-Brasileiro de Pneumologia, em Dezembro de 2006

Copyright © 2009. Sociedade Portuguesa de Pneumologia
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