The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Systemic Lupus Erythematosus Manifested as Pancytopenia during Tuberculosis Treatment

폐결핵으로 치료 중 범혈구감소증으로 발현한 전신홍반루푸스

  • Bae, Won (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Kang, Jieun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Park, So-Hee (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Kang, Hyung Koo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Koo, Hyeon-Kyoung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Park, Hye Kyeong (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Lee, Sung-Soon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital)
  • 배원 (인제대학교 일산백병원 호흡기내과) ;
  • 강지은 (인제대학교 일산백병원 호흡기내과) ;
  • 박소희 (인제대학교 일산백병원 호흡기내과) ;
  • 강형구 (인제대학교 일산백병원 호흡기내과) ;
  • 구현경 (인제대학교 일산백병원 호흡기내과) ;
  • 박혜경 (인제대학교 일산백병원 호흡기내과) ;
  • 이성순 (인제대학교 일산백병원 호흡기내과)
  • Published : 20210000
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Abstract

A 49-year-old Chinese woman presented to Ilsan Paik Hospital emergency department with fever and general weakness. Chest computed tomography revealed cavity and peribronchial nodules and consolidation in the right upper lobe. A diagnosis of suspected active tuberculosis was made. A review of the patient’s medication prescribed at another hospital indicated that she had been taking antituberculosis medication for several months. Initially, the patient had anemia and mild thrombocytopenia. In addition, she developed leukopenia and her thrombocytopenia worsened. After discontinuing the antituberculosis medication, her pancytopenia initially improved, but was aggravated again after starting on antituberculosis drugs. Despite discontinuing the antituberculosis medication again, her pancytopenia progressed. As she had a high anti-nuclear antibody titer, another systemic disease was suspected. She was diagnosed with systemic lupus erythematosus and her leukopenia and thrombocytopenia improved after initiation of treatment with systemic steroids and antimalarial drugs.

결핵약은 혈액장애를 비롯한 많은 부작용을 유발할 수 있다. 그렇지만 결핵약에 의한 범혈구감소증은 매우 드물다. 해당 환자에서 결핵약을 복용하던 중 지속되는 범혈구감소증에 대해 약제 관련 부작용 가능성을 가장 먼저 감별하고자 하였으나, 약제와 무관한 다른 질환의 발현으로 확인되었다. 가장 가능성이 높은 원인 질환을 먼저 고려하는 것이 중요하지만, 환자가 여러 질환을 가지고 있을 수 있다는 점을 항상 명심해야 한다.

Keywords