Renal Tuberculosis Mimicking a Systemic Lupus Erythematosus Renal Flare

Author(s):

Sameh Sayhi*, Mohamed Salah Hamdi, Erij Yahyaoui, Ghada Mabrouk, Nour Guediche, Faida Ajili and Nadia Ben Abdelhafidh

Infections are frequent and grave problems in patients with systemic lupus erythematosus. Infections have been incriminated in initiating the disease and are usually responsible for relapses. However, infections such as tuberculosis can also mimic systemic lupus erythematosus flares resulting in challenging differential diagnosis and often delayed therapy. In this regard, we report the case of a twenty-six year-old male in whom diagnosis of systemic lupus erythematosus with joint, pleural and hematological involvement was retained. The patient presented three months after initial diagnosis fever, dry cough and mild proteinuria with laboratory evidence of inflammation. Renal flare related to systemic lupus or Sjögren’s syndrome was suspected and thus renal biopsy was performed. Histological examination revealed granuloma with caseating necrosis associated with sings of tubulointersitial nephropathy. Chest and abdominal computed tomography revealed the presence of an excavated nodule of the right lung but also three nodular lesions of the right kidney ranging from 4 to 11 mm. Diagnosis of pulmonary and renal tuberculosis was retained. Treatment with oral anti-tuberculosis drugs was initiated with favorable outcome.