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Abstract：
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.
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.
摘要：
背景：风湿性疾病患者的结核病（TB）发生率高于普通人群。这项研究旨在描述在参考中心接受治疗的患有结核病和风湿性疾病（RD）的儿童和青少年。
方法：在里约热内卢的儿童结核病参考中心调查了一系列结核病病例，巴西,从1995年到2022年。
结果：纳入了15例基础RD和TB患者，其中8例（53%）为女性。RD诊断的平均年龄为7.10岁（SD±0.57岁），结核病诊断时的平均年龄为9.81岁(SD±0.88岁)。肺结核(PTB)9例,肺外胸膜结核6例(2例),关节/骨关节(1)，皮肤（1），眼（1），和腹膜（1）-进行了描述。在15例患者中观察到的RD包括幼年特发性关节炎(9)，青少年系统性红斑狼疮（3），青少年皮肌炎(1)，结节性多动脉炎（1），坏疽性脓皮病（1）。在免疫抑制剂/免疫生物学中，甲氨蝶呤（8）是最常用的，其次是皮质类固醇（6），依那西普（2），霉酚酸酯（1），环孢菌素A(1),阿达木单抗（1），和托珠单抗（1）。最常见的症状是发烧和体重减轻，并注意到PTB病例占多数。GeneXpertMTB/RIF®在6例患者中进行，其中2例检测到无利福平耐药性；XpertUltra®在5例患者中进行，在三个人中检测到了具有不确定的利福平抗性的痕迹。一名女性患者停止治疗，另一个人去世了。
结论：病例系列证明了在使用免疫抑制剂/免疫生物学药物的RD患者中怀疑和调查结核病的重要性，特别是在结核病发病率高的国家，如巴西。
方法：在里约热内卢的儿童结核病参考中心调查了一系列结核病病例，巴西,从1995年到2022年。
结果：纳入了15例基础RD和TB患者，其中8例（53%）为女性。RD诊断的平均年龄为7.10岁（SD±0.57岁），结核病诊断时的平均年龄为9.81岁(SD±0.88岁)。肺结核(PTB)9例,肺外胸膜结核6例(2例),关节/骨关节(1)，皮肤（1），眼（1），和腹膜（1）-进行了描述。在15例患者中观察到的RD包括幼年特发性关节炎(9)，青少年系统性红斑狼疮（3），青少年皮肌炎(1)，结节性多动脉炎（1），坏疽性脓皮病（1）。在免疫抑制剂/免疫生物学中，甲氨蝶呤（8）是最常用的，其次是皮质类固醇（6），依那西普（2），霉酚酸酯（1），环孢菌素A(1),阿达木单抗（1），和托珠单抗（1）。最常见的症状是发烧和体重减轻，并注意到PTB病例占多数。GeneXpertMTB/RIF®在6例患者中进行，其中2例检测到无利福平耐药性；XpertUltra®在5例患者中进行，在三个人中检测到了具有不确定的利福平抗性的痕迹。一名女性患者停止治疗，另一个人去世了。
结论：病例系列证明了在使用免疫抑制剂/免疫生物学药物的RD患者中怀疑和调查结核病的重要性，特别是在结核病发病率高的国家，如巴西。
