Pulmonary tuberculosis presenting as henoch-schönlein purpura: Case report and literature review

Immunoglobulin A Vasculitis After Initiation of Treatment for Tuberculous Pleurisy: A Case Report and Literature Review

Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein purpura (HSP), is a disease that causes inflammation and bleeding in small blood vessels in the skin, joints, intestines, and kidneys. Although various infections and chemicals are known to be triggers, the underlying cause of IgAV remains unknown. Here, we describe a case of an 86-year-old male patient with IgAV that developed after anti-tuberculosis treatment for tuberculous pleurisy. There have been several case reports implicating Mycobacterium tuberculosis and other acid-fast bacterium in the development of IgAV, but only a few case reports implicating anti-tuberculous drugs. This case highlights the importance of recognizing that IgAV can be caused by anti-tuberculous drugs.

IgA Vasculitis Complicated by Both CMV Reactivation and Tuberculosis

Immunoglobulin A (IgA) vasculitis is the most common systemic vasculitis in the pediatric population. We present the case of a patient with IgA vasculitis with nephritis who developed cytomegalovirus (CMV) infection followed by Mycobacterium tuberculosis infection. In the literature, there are a few cases of IgA nephropathy accompanied by reactivation of CMV or tuberculosis. To the best of our knowledge, this is the first reported case of IgA vasculitis complicated by both CMV reactivation and tuberculosis. It is important to detect infections in patients with IgA vasculitis because they can induce and exacerbate the symptoms of the disease. Effective antimicrobial treatment facilitates the management of proteinuria and slows down the decline of renal function. Immunosuppressive therapy is a risk factor for reactivation of latent infections and makes patients more susceptible to its generalized and complicated course. This can be prevented by actively screening for hidden sites of infection.

Common and Rare Hematological Manifestations and Adverse Drug Events during Treatment of Active TB: A State of Art

Background: Tuberculosis (TB) can seriously affect the hematopoietic system, with involvement of both myeloid and lymphoid cell lines as well as plasma components. These hematological changes act as a marker for the diagnosis, prognosis and response to therapy. Methods: We searched PubMed, Scopus, Google Scholar, EMBASE, Cochrane Library and WHO websites from 1950 to May 2021 for papers on the interaction between TB and common and rare hematological manifestation. Results: Hematological reactions in patients with TB are possible in both young and old women and men but seem more frequent in the elderly, and they can be predictors of both diagnosis and worse outcome for TB, regardless of whether it is pulmonary, extra pulmonary or miliary. Even anti-TB therapies can cause hematological adverse events, among which some are serious and rare and can compromise the patient’s recovery pathway to completing treatment. Conclusion: Hematological screening and follow-up, including complete blood count and coagulation, are always necessary both at the diagnosis of TB and during antitubercular treatment in order to monitor hematological parameters. Short therapy regimens for multidrug-resistant TB (MDR-TB) may also be useful for reducing hematological toxicity, especially in contexts where this cannot be monitored. Close monitoring of drug interactions and hematological adverse events is always recommended.

The coexistence of IgA vasculitis and tuberculosis: a case-based review

Immunoglobulin (Ig) A vasculitis (IgAV), formerly known as Henoch-Schonlein purpura (HSP), is a relatively uncommon form of vasculitis primarily targeting the skin, gastrointestinal system, and the kidneys. Although the pathogenesis has not yet been well identified, several triggering factors, such as infections, drugs, have been implicated in the development of IgAV. Tuberculosis (TB), albeit rare, may precipitate IgAV. Herein, we have presented a case manifested by purpuric skin rash and proteinuria 6 weeks following diagnosis of pulmonary tuberculosis while receiving anti-TB drugs. The case was diagnosed as having active tuberculosis and TB-related IgA vasculitis with multi-organ involvement. In this case-based review, we recruited cases with TB-related Ig A vasculitis from the literature and discussed the features of tuberculosis that mimic vasculitides and vice versa. We also discussed the difficulties in diagnosis and the therapeutic approach in the light of the literature.

Study of the association of interferon-γ gene polymorphisms and Th1/Th2 balance in tuberculosis susceptibility

OBJECTIVES

This study investigated and analyzed the association of interferon-γ (IFN-γ) gene polymorphisms and Th1/Th2 balance in tuberculosis susceptibility.

METHODS

From January 2018 to January 2020, 121 tuberculosis patients that were hospitalized for initial treatment and were chosen as the pulmonary tuberculosis group, and another 80 healthy individuals with physical examination in the same period were selected as the control group. The genetic distribution of IFN-γ +874 sites in the two sets of subjects was detected by sequence-specific primer PCR (PCR-SSP), the serum IFN-γ level was detected by ELISA, and the ratio of Th1 and Th2 on cells in two sets of subjects were detected by flow cytometry. Subsequently, we compared the differences in IFN-γ degree and the changes in Th1/Th2 in patients with different genotypes.

RESULTS

The difference in the distribution of IFN-γ (+874 T/A) genotype frequencies between the two groups of subjects was significantly different (P<0.05), and the frequency of A allele in the tuberculosis group was clearly higher than that in the control group (P<0.05). Compared with the control group, the Th1 cells percentage in the pulmonary tuberculosis group decreased remarkably, the Th2 cells percentage increased significantly, while the Th1/Th2 ratio was notably decreased (P<0.05). In addition, the Th1/Th2 ratio in tuberculosis patients with an IFN-γ (+874 T/A) genotype AA was remarkably lower than those with AT+TT genotype (P<0.05).

CONCLUSION

An AA genotype with IFN-γ (+874 T/A) is a susceptible genotype for tuberculosis. The mechanism may be related to the imbalance of Th1/Th2 which is more likely to occur in patients with AA genotype. This can lead to a decline in immune function of the body, making it more susceptible to infection with mycobacterium which induces tuberculosis.