Skip to main content

Advertisement

SpringerLink
Log in

Can Lupus Flares be Associated with Tuberculosis Infection?

  • Published:
Clinical Reviews in Allergy & Immunology Aims and scope Submit manuscript

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease that frequently requires treatment with high doses of corticosteroids and immunosuppressive drugs. Primary defects in the innate immunity also contribute to an increased susceptibility to infections. Patients with SLE are at an increased risk for infections with several pathogens, among them Mycobacterium tuberculosis, which is a significant cause of morbidity and mortality, especially in endemic regions. TB infection requires awareness for several reasons: first, TB infection thrives under conditions of immunosuppression, may it be secondary to the disease itself or its treatment. Second, shared antigens by mycobacteria and autoantigens have been described, which may be targets for autoantibodies. We present four Brazilian patients, in whom a diagnosis of tuberculosis was determined during or following persistent flares of their disease. The association of SLE and TB is discussed, as well as different aspects of the tuberculosis infection in this selected population, and its possible role in the course of SLE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shoenfeld Y, Isenberg D (1989) The mosaic of autoimmunity. Immunol Today 10:123–126

    Article  CAS  PubMed  Google Scholar 

  2. Shoenfeld Y, Gilburd B, Abu-Shakra M, Amital H, Barzilai O, Berkun Y et al (2008) The mosaic of autoimmunity: genetic factors involved in autoimmune diseases—2008. Isr Med Assoc J 10:3–7

    PubMed  Google Scholar 

  3. Shoenfeld Y, Zandman-Goddard G, Stojanovich L, Cutolo M, Amital H, Levy Y et al (2008) The mosaic of autoimmunity: hormonal and environmental factors involved in autoimmune diseases—2008. Isr Med Assoc J 10:8–12

    PubMed  Google Scholar 

  4. Shoenfeld Y, Blank M, Abu-Shakra M, Amital H, Barzilai O, Berkun Y et al (2008) The mosaic of autoimmunity: prediction, autoantibodies, and treatment in autoimmune diseases—2008. Isr Med Assoc J 10:13–19

    PubMed  Google Scholar 

  5. Sherer Y, Gorstein A, Fritzler MJ, Shoenfeld Y (2004) Autoantibody explosion in systemic lupus erythematosus: more than 100 different antibodies found in SLE patients. Sem Arth Rheum 34:501–537

    Article  CAS  Google Scholar 

  6. Fessler BJ (2002) Infectious diseases in systemic lupus erythematosus: risk factors, management and prophylaxis. Best Pract Res Clin Rheumatol 16:281–291

    Article  PubMed  Google Scholar 

  7. Gaipl US, Munoz LE, Grossmayer G, Lauber K et al (2007) Clearance deficiency and systemic lupus erythematosus (SLE). J Autoimmunity 28:114–121

    Article  Google Scholar 

  8. Lang KS, Burow A, Kurrer M, Lang PA, Recher M (2007) The role of the innate immune response in autoimmune disease. J Autoimmunity 29:206–212

    Article  CAS  Google Scholar 

  9. Zandman-Goddard G, Shoenfeld Y (2003) SLE and infections. Clin Rev All Immunol 25:29–39

    Article  Google Scholar 

  10. Woon-Leung NG (2006) Infections in patients with systemic lupus erythematosus. APLAR J Rheumatol. 9:89–97

    Article  Google Scholar 

  11. Pryor BD, Bologna SG, Kahl LE (1996) Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus. Arthritis Rheum 39:1475–82

    Article  CAS  PubMed  Google Scholar 

  12. Hill HM, Kirshbaum JD (1956) Military tuberculosis developing during prolonged cortisone therapy of systemic lupus erythematosus. Ann Intern Med 44:781–790

    CAS  PubMed  Google Scholar 

  13. Balakrishnan C, Mangat G, Mittal G, Joshi VR (1998) Tuberculosis in patients with systemic lupus erythematosus. J Assoc Physicians India 46:682–683

    CAS  PubMed  Google Scholar 

  14. Sayarlioglu M, Inanc M, Kamali S et al (2004) Tuberculosis in Turkish patients with systemic lupus erythematosus: increased frequency of extrapulmonary localization. Lupus 13:274–278

    Article  CAS  PubMed  Google Scholar 

  15. Vitorio-Navarra STG, Dy EER, Arroyo CG et al (1996) Tuberculosis among Filipino patients with systemic lupus erythematosus. Semin Arthritis Rheum 26:628–634

    Article  Google Scholar 

  16. Erdozain J-G, Ruiz-Irastorza G, Egurbide M-V et al (2006) High risk of tuberculosis in systemic lupus erythematosus? Lupus 15:232–235

    Article  CAS  PubMed  Google Scholar 

  17. Tam LS, Li EK, Wong SM, Szeto CC (2002) Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong-Kong. Scand J Rheumatol 31:296–300

    Article  PubMed  Google Scholar 

  18. Hou CL, Tsai YC, Chen LC et al (2008) Tuberculosis infection in patients with systemic lupus erythematosus: pulmonary and extra-pulmonary infection compared. Clin Rheumatol 27:557–563

    Article  PubMed  Google Scholar 

  19. Hernández-Cruz B, Sifuentes-Osornio J, Ponce-de-León Rosales S, Ponce-de-León Garduño A, Díaz-Jouanen E (1999) Mycobacterium tuberculosis infection in patients with systemic rheumatic diseases. A case-series. Clin Exp Rheumatol 17:289–296

    PubMed  Google Scholar 

  20. Mok MY, Lo Y, Chan TM, Wong WS, Lau CS (2005) Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy. J Rheumatol 32:609–615

    CAS  PubMed  Google Scholar 

  21. Yun JE, Lee SW, Kim TH, Jun JB, Jung S, Bae SC, Kim TY, Yoo DH (2002) The incidence and clinical characteristics of Mycobacterium tuberculosis infection among systemic lupus erythematosus and rheumatoid arthritis patients in Korea. Clin Exp Rheumatol 20:127–132

    CAS  PubMed  Google Scholar 

  22. Feng PH, Tan TH (1982) Tuberculosis in patients with systemic lupus erythematosus. Ann Rheum Dis 41(1):11–14

    Article  CAS  PubMed  Google Scholar 

  23. Sousa DC, Medeiros MMC (2008) Lúpus eritematoso sistêmico e tuberculose renal: descrição de nove casos. Rev Bras Reumatol. 48:2–6

    Article  Google Scholar 

  24. Favalli EG, Desiati F, Atzeni F, Sarzi-Puttini P, Caporali R, Pallavicini FB et al (2009) Serious infections during anti-TNFalpha treatment in rheumatoid arthritis. Autoimmun Rev 8:266–273

    Article  CAS  PubMed  Google Scholar 

  25. Doria A, Canova M, Tonon M, Zen M, Rampudda E, Bassi N et al (2008) Infections as triggers and complications of systemic lúpus erythematosus. Autoimmun Rev 8:24–28

    Article  CAS  PubMed  Google Scholar 

  26. Lalvani A, Millington KA (2008) Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmun Rev 8:147–152

    Article  CAS  PubMed  Google Scholar 

  27. Sela O, El-Roeiy A, Pick AI, Shoenfeld Y (1987) Immunoglobulin levels in Klebsiella and TB infection. Immunol Lett 15:117–220

    Article  CAS  PubMed  Google Scholar 

  28. Shoenfeld Y, Isenberg DA (1988) Mycobacteria and autoimmunity. Immunology Today 9:178–181

    Article  CAS  PubMed  Google Scholar 

  29. Purice S, Mitu S, Popescu T et al (1982) The relationship between systemic lupus erythematosus and tuberculosis. Med Intern 20:191–196

    CAS  Google Scholar 

  30. Shoenfeld Y, Vilner Y, Coates AR et al (1986) Monoclonal anti-tuberculosis antibodies react with DNA and monoclonal anti-DNA autoantibodies react with Mycobacterium tuberculosis. Clin Exp Immunol 66:255–261

    CAS  PubMed  Google Scholar 

  31. Amital-Teplizic H, Avinoach I, Coates AR et al (1989) Binding of monoclonal anti-DNA and anti-TB glycolipids to brain tissue. Autoimmunity 4:277–287

    Article  Google Scholar 

  32. Sela O, El-Roeiy A, Isenberg DA, Kennedy RC, Colaco CB, Pinkhas J, Shoenfeld Y (1987) A common anti-DNA antibody idiotype in sera of patients with active pulmonary tuberculosis. Arthritis Rheum 30:50–55

    Article  CAS  PubMed  Google Scholar 

  33. Isenberg DA, Maddison P, Swana G, Jones M, Dudeney C, El-Roeiy A, Shoenfeld Y (1987) Profile of autoantibodies in the sera of patients with tuberculosis, Klebsiella and other gram-negative infections. Clin Exp Immunol 67:516–523

    CAS  PubMed  Google Scholar 

  34. Teplizki H, Buskila D, Isenberg DA, Coates ARM, Sukenik S, Horowitz J, Shoenfeld Y (1987) Low serum anti-TB glycolipid antibodies titer in the sera of patients with SLE as an indicator of CNS involvement. J Rheumatol 14:507

    CAS  PubMed  Google Scholar 

  35. Amital-Teplizki H, Avinoach I, Coates ARM, Kooperman O, Blank M, Shoenfeld Y (1989) Binding of monoclonal anti-DNA and anti-TB glycolipid to brain tissue. Autoimmunity 4:277–287

    Article  CAS  PubMed  Google Scholar 

  36. Blank M, Mendlovic S, Mozes E, Coates ARM, Shoenfeld Y (1991) Induction of SLE in naive mice with T cell lines specific for human anti-DNA antibody SA-1 (16/6 Id+) and for mouse tuberculous antibody (TB/68) antibody (16/6 Id+). Clin Immunol Immunopathol 60:471–483

    Article  CAS  PubMed  Google Scholar 

  37. Harats D, Yacov N, Gilburd B, Shoenfeld Y, George J (2002) Oral tolerance with heat shock protein 65 attenuates mycobacterium tuberculosis-induced and high-fat-diet-driven atherosclerotic lesions. J Am Col Cardiol 7:1333–1338

    Article  Google Scholar 

  38. Mandal K, Jahangiri M, Xu Q (2004) Autoimmunity to heat shock proteins in atherosclerosis. Autoimmun Rev 3:31–37

    Article  CAS  PubMed  Google Scholar 

  39. Quintana FJ, Cohen IR (2005) DNA vaccines coding for heat-shock proteins (HSP): tools for the activation of HSP-specific regulatory T cells. Expert Opin Biol Ther 5:545–554

    Article  CAS  PubMed  Google Scholar 

  40. Alard JE, Dueymes M, Youinou P, Jamim C (2007) Modulation of endothelial cell damages by anti-Hsp60 autoantibodies in systemic autoimmune diseases. Autoimmun Rev 6:438–443

    Article  CAS  PubMed  Google Scholar 

  41. Tishler M, Shoenfeld Y (1996) Anti-heat-shock protein antibodies in rheumatic and autoimmune diseases. Semin Arthritis Rheum 26:558–563

    Article  CAS  PubMed  Google Scholar 

  42. Adams JS, Hewison M (2008) Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab 4:80–90

    Article  CAS  PubMed  Google Scholar 

  43. Arnson Y, Amital H, Shoenfeld Y (2007) Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis 66:1137–42

    Article  CAS  PubMed  Google Scholar 

  44. Nnoaham KE, Clarke A (2008) Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol 37:113–9

    Article  PubMed  Google Scholar 

  45. Orbach H, Zandman-Goddard G, Amital H, Barak V, Szekanecz Z, Szucs G, Danko K, Nagy E, Csepany T, Carvalho JF, Doria A, Shoenfeld Y (2007) Novel biomarkers in autoimmune diseases: prolactin, ferritin, vitamin D, and TPA levels in autoimmune diseases. Ann N Y Acad Sci 1109:385–400

    Article  CAS  PubMed  Google Scholar 

  46. Carvalho JF, Blank M, Kiss E, Tarr T, Amital H, Shoenfeld Y (2007) Anti-vitamin D, vitamin D in SLE: preliminary results. Ann N Y Acad Sci 1109:550–557

    Article  CAS  PubMed  Google Scholar 

  47. Papadimitraki ED, Bertsias GK, Boumpas DT (2007) Toll like receptors and autoimmunity: a critical appraisal. J Autoimmunity 29:310–318

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

    F. M. Ribeiro, E. M. Klumb, G. Lannes, F. R. E. Ribeiro & E. M. M. Albuquerque

  2. Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, 52621, Israel

    M. Szyper-Kravitz & Y. Shoenfeld

  3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Y. Shoenfeld

  4. Research of Autoimmune Diseases, Tel-Aviv University, Tel-Aviv, Israel

    Y. Shoenfeld

Authors
  1. F. M. Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Szyper-Kravitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. M. Klumb
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Lannes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. R. E. Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. M. M. Albuquerque
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y. Shoenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Shoenfeld.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ribeiro, F.M., Szyper-Kravitz, M., Klumb, E.M. et al. Can Lupus Flares be Associated with Tuberculosis Infection?. Clinic Rev Allerg Immunol 38, 163–168 (2010). https://doi.org/10.1007/s12016-009-8149-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12016-009-8149-7

Keywords

Search

Navigation