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Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 2009 Mart; 16 (1) Sistemik lupus eritematozus tanilibir olguda akciger, plevra ve bagirsak tuberkulozu: olgu sunumu Şule Kaya*, Necla Songur*, Onder Ozturk*, Metin I.Ciris**, Ercan Tunc***, Yildiran Songur****, M. Cem Kockar****, Ahmet Akkaya* Ozet Sistemik Lupus Eritematozus (SLE), bircok organ sistemlerinin tutulumu ile karakterize otoimmun bir hastaliktir. Son zamanlarda, SLE hastalarinda firsatci enfeksiyon riskinde, ozellikle de akciger tuberkulozu ve akciger disi organ tuberkulozunda artma olduguna dair bir cok yayin bulunmaktadir. Altiyildir SLE, diffuz proliferatif glomerulonefrit (DPGN) ve hipertansiyon tanilariile takip edilen 35 yasinda bayan hasta usume, titreme, ates, halsizlik ve kilo kaybiyakinmalariile klinigimize basvurdu. Akciger grafisinde, sol akciger orta ve alt zonda efuzyon ile uyumlu acikligiyukaribakan homojen dansite artisi izlendi. Hastanin oykusunden 1 ay once akut batin on tanisiyla sag hemikolektomi operasyonu gecirdigi ogrenildi. Ameliyat materyalinin patoloji sonucu kazeifikasyon nekrozu iceren granulomatoz inflamasyon ile uyumlu idi. Bronkoskopik biyopsilerde granulom gorulmedi. Brons lavajinin direkt bakisinda asido rezistan bakteri (ARB) negatifti ve aynimateryalin kulturunde ARB uremedi. Plevral sivida adenozin deaminaz duzeyi (ADA) 182U/L idi. Klinik ve laboratuar bulgulariile lupus aktivasyonu dislanan olguda kullanmakta oldugu dusuk doz kortizon tedavisine devam edildi. Bagirsak tuberkulozu, yayma negatif akciger tuberkulozu ve tuberkuloz plorezi tanilari ile antituberkuloz tedavi baslandi. Antituberkuloz tedavi ile klinik ve radyolojik duzelme gorulen olguda tedavi 9 aya tamamlandi. Anahtar kelimeler: Akciger tuberkulozu, akciger disi organ tuberkulozu, sistemik lupus eritematozus Abstract Pulmonary, pleural and intestinal tuberculosis in a case with the diagnosis of systemic lupus erythematosus: a case report Systemic lupus erythematosus (SLE) is an aotuimmune disease that characterized multisystem involvement. Recently, there are many reports about an increased risk for opportunistic infections, especially pulmonary and extrapulmonary tuberculosis in patients with SLE. A 35-year old female patient, who had been followed with the diagnosis of SLE, diffuse glomerulonephritis and hypertension for six years, admitted to our clinic with the complaints of chill, fever, fatigue and weight loss. The chest roentgenogram showed an increased homogenous density in the left middle and the basal lung zones. It was learned that the patient was undergone the operation of hemicolectomi with the diagnosis of acute abdomen one month ago. The pathological examination of the specimen was showed a granulomatous inflammation with caseification necrosis. Any granuloma was seen on the bronchoscopic biopsies. The direct examination and culture of the bronchial lavage for acid -fast bacilli was negative. The level of adenosine deaminase in pleural fluid was 182 U/L. With the laboratory and clinical findings, activation of lupus was excluded and the low dose cortisone therapy was continued. The antituberculosis treatment was given with the diagnosis of bowel tuberculosis, sputum smear negative pulmonary tuberculosis and tuberculous pleurisy. By the clinical and radiological improvement, the treatment was completed in 9 months. Key words: Pulmonary tuberculosis, extrapulmonary tuberculosis, systemic lupus erythematosus

Sistemik lupus eritematozus tanılıbir olguda akciğer, plevra ve bağırsak tüberkülozu: olgu sunumu