A mycobacterial infection and the risk of newly diagnosed Sjögren’s syndrome

Abstract

Background. TB is a widespread infection, which has various clinical forms, can be asymptomatic and is very commonly associated with autoimmune diseases such as SLE, SS, RA, SS, DM and others not only due to immunosuppressive treatment, but also to characteristic immunological disorders Case report. A 26-year-old woman presented to a rheumatologist with a list of immunological investigations performed 4 months ago (RF Ig M- 125 IU / ml, positive; ANA, Anti SSA Ig G, Anti-SSB Ig G, Anti Ro 52, Ig G - intensely positive, Anti RNP / Sm, Ig G-positive, Anti p ANCA Ig G- positive. During the interview we found out that the patient had symptoms like dryness in the mouth, dryness of the eyes, signs of Raynaud's syndrome, fatigue, left unattended. It all started 6 months ago, she performed the hemogram where ESR was 50mm/h, which put her on guard and performed the chest x-ray where was a consolidation area in S1- S2 on the right with nodulation around. At the medical indication she was given antibiotic therapy for 14 days, without radiological dynamic. The computer tomography confirms the infiltration in S2 with the air bronchogram, a nodular aspect of it and the presence of calcifications (characteristic tomographic changes for an inflammatory process of type Tuberculosis TB, with tomographic signs for the activity of the inflammatory process). Also, the patient underwent fibrobronchoscopy twice -aspirated BAAR, GeneXpert, classical culture, all negative and transbronchial biopsy with results that did not confirm TB. It should be mentioned that in childhood the patient contacted the patient infected with TB, BAAR positive and followed the TB treatment. ESR and immunological investigations were re-evaluated in dynamics: 44 mm / h; Anti-Nuclear Antibodies: 146.3 U / ml; Anti-SS-A antibodies: 132.3 U / ml; Anti-SS-B Antibodies: 192.3 U / ml; Ocular assessment suggested keratoconjunctivitis sicca. She was diagnosed with primary Sjögren’s syndrome (pSS) and was administered with Methilprednisolone 500 mg per day, 3 days. In dynamics without immunological and clinical changes, but with CT image-infiltrative process in the upper lobe of the right lung with solitary cavity formation, suggestive for evolutive infiltrative TB. The lack of positive dynamics after pulsterapy and imaging changes led to the suspicion of TB as comorbidity. The patient was reinvestigated with the diagnosis of TB was confirmed, followed by anti-tuberculosis treatment with positive dynamics. She went to the rheumatologist to monitor and administer the treatment for Sjogren's Syndrome. Conclusions. The predisposing factors of tuberculosis infection in this patient include immunopathological disturbance secondary to pSS. But pSS alone does not seen to be a susceptible factor for tuberculosis infection. The discrepant pathological processes involved in these two distinguished disease profiles could be an explanation for different susceptibility of tuberculosis.