Autoimmune Diseases

Extrapulmonary Tuberculosis (EPTB)

Overview

Tuberculosis is not an autoimmune disease, however when it spreads outside the lungs, it can affect any part of the body and thus it can imitate many autoimmune diseases, especially other systemic diseases such as scleroderma and lupus. (Also see What is Scleroderma? and Systemic Lupus Erythematosus)

What is Tuberculosis? Tuberculosis is a bacterial disease usually affecting the lungs (pulmonary TB). Other parts of the body can also be affected, for example lymph nodes, kidneys, bones, joints, etc. (extrapulmonary TB). New York State Department of Health.

Causes

Tuberculosis is caused by mycobacterium tuberculosis. Over one third of the world's population has latent or active mycobacterial infection.

Pulmonary tuberculosis is contagious and is usually spread by coughs and sneezes after prolonged close contact. So, it is much more likely to catch it from a family member or co-worker who has not yet had sufficient antibiotics, than from exposure in stores or public transportation.

Extrapulmonary Tuberculosis (EPTB)

Tuberculosis is most well known for affecting the lungs. However in about 20% of cases it occurs outside of the lungs, and then it is called extrapulmonary, miliary, or disseminated tuberculosis.

Case Report: Extra pulmonary tuberculosis presenting as fever with massive splenomegaly and pancytopenia. We report the case of a 13-year old male who presented with fever, weight loss, pallor and massive splenomegaly with pancytopenia. PubMed, IDCases. (Also see Liver and Spleen Involvement)

Autoimmunity and Mycobacterium

The effect of anti-tuberculosis treatment on levels of anti-phospholipid and anti-neutrophil cytoplasmatic antibodies in patients with active tuberculosis. Anti-TB treatment may induce normalization of anti-lactoferrin and anti-myeloperoxidase (MPO), and de novo anti-proteinase 3 and MPO formation. PubMed, Rheumatol Int.

Mycobacterium tuberculosis triggers autoimmunity? It is important to screen all tuberculosis patients for autoantibody profile and should be followed up after the treatment for any flaring up of autoimmune related symptoms. PubMed, Indian J Tuberc.

Scleroderma and Tuberculosis

Systemic Sclerosis (SSc) and the Risk of Tuberculosis (TB). In this nationwide study, the incidence of TB infection was significantly higher among patients with SSc than in controls without SSc and special care should be taken in managing patients with SSc who are at high risk for TB. PubMed, J Rheumatol.

Diagnosis

Identification and Classification of Differentially Expressed Genes and Network Meta-Analysis Reveals Potential Molecular Signatures Associated With Tuberculosis. The proposed approach is based on gene-expression profiling, and network analysis approaches predict some unknown TB-associated genes, which can be considered (or can be tested) as reliable candidates for further studies. PubMed, Front Genet, 2019 Nov 4;10:932.

Symptoms

Extrapulmonary Tuberculosis Symptoms. Mycobacteria can infect virtually any part of the body and onset slowly, imitating many other diseases. General symptoms include fatigue, malaise, fever, weight loss, anorexia, fever. It can affect the kidneys, bladder, muscles, joints, bones, heart, central nervous system, lymph nodes, and gastrointestinal tract. Patient.info.

Treatments

High Incidence of New-Onset Joint Pain in Patients on Fluoroquinolones as Antituberculous Treatment. There is a high incidence of joint pain in patients receiving antituberculous treatment, when fluoroquinolones are administered as compared to pyrazinamide. PubMed, Respiration, 2020 Jan 14:1-7.

Risk of active tuberculosis in patients with inflammatory arthritis receiving TNF inhibitors (TNFi): a look beyond the baseline tuberculosis screening protocol. ‘Early TB’ was exceeded by TB occurring after 1 year of TNFi treatment, thereby, suggesting that further TB prevention measures were required. PubMed, Clin Rheumatol, 2018 Sep;37(9):2391-2397. (Also see Biologic Agents)

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