Tuberculosis among children and adolescents with rheumatic diseases - case series

• Published in: Pediatric Rheumatology 2023-11, Vol.21 (1), p.1-136, Article 136
• Main Authors: Lima, Lenita de Melo, Fonseca, Adriana Rodrigues, Sant'Anna, Clemax Couto, Parente, Ana Alice Amaral Ibiapina, Aurilio, Rafaela Baroni, Sant'Anna, Maria de Fátima Bazhuni Pombo
• Format: Article
• Language: English
• Subjects: Adalimumab; Age; Anemia; Arthritis; Children; Diseases; Fever; Immunosuppressive agents; Infections; Juvenile idiopathic arthritis; Leukopenia; Lupus; Medical research; Medicine, Experimental; Mycobacterium tuberculosis; Mycophenolate mofetil; Patients; Pediatric rheumatic Diseases; Pediatrics; Rheumatic diseases; Rheumatology; Rifampin; Short Report; Steroids; Systemic lupus erythematosus; Tuberculosis; Tumor necrosis factor-TNF
• ISSN: 1546-0096; 1546-0096
• DOI: 10.1186/s12969-023-00918-4

Background: Rheumatic patients have a higher frequency of tuberculosis(TB) than the general population. This study aimed to describe children and adolescents with TB and rheumatic diseases(RD) who were being treated in a reference center. Methods: A series of TB cases were investigated in a reference center for childhood TB in Rio de Janeiro, Brazil, from 1995 to 2022. Results: Fifteen patients with underlying RD and TB were included with 8(53%) being female. The mean age at RD diagnosis was 7.10years (SD ± 0,57 years), and the mean age at TB diagnosis was 9.81 years(SD ± 0.88 years). A total of 9 cases of pulmonary TB(PTB) and 6 cases of extrapulmonary TB—pleural(2), joint/osteoarticular(1), cutaneous(1), ocular(1), and peritoneal(1)- were described. The RD observed in the 15 patients included juvenile idiopathic arthritis(9), juvenile systemic lupus erythematosus(3), juvenile dermatomyositis(1), polyarteritis nodosa(1), and pyoderma gangrenosum(1). Among the immunosuppressants/immunobiologics, methotrexate(8) was the most commonly used, followed by corticosteroids(6), etanercept(2), mycophenolate mofetil(1), cyclosporine A(1), adalimumab(1), and tocilizumab(1). The most common symptoms were fever and weight loss, and a predominance of PTB cases was noted. GeneXpert MTB/RIF® was performed in six patients and was detectable in two without rifampicin resistance; Xpert Ultra® was performed in five patients, and traces with indeterminate rifampicin resistance were detected in three. One female patient discontinued treatment, and another passed away. Conclusions: The case series demonstrated the importance of suspecting and investigating TB in RD affected patients who are using immunosuppressants/ immunobiologics, particularly in countries with high rates of TB such as Brazil.