Latent Tuberculosis Activation Due to Short-Term Glucocorticoid Use in Acute Systemic Lupus Erythematosus

We present a case of a 57-year-old Honduran male with no past medical history who initially presented to the hospital for blurred vision, but was ultimately admitted for hypoxia and acute kidney injury. His blurred vision led to an ophthalmic examination revealing bilateral retinal detachments. The evaluation for spontaneous retinal detachment led to the discovery of a positive antinuclear antibody (ANA) and interferon gamma release assay (IGRA) for tuberculosis (TB). At the time of admission, chest radiography was negative for evidence of active TB, and all sputum testing was negative. Further workup revealed the patient met criteria for acute onset systemic lupus erythematosus (SLE). Due to worsening clinical condition, he was started on 20 mg prednisone for the treatment of acute SLE along with rifampin for latent TB. However, with ongoing clinical deterioration, repeat imaging was obtained, and it was revealed that he had conversion of latent to active TB after only 13 days of glucocorticoid exposure. Both diagnoses were later confirmed by biopsy. This case endeavors to explore the potential causes for activation of latent TB from the initiation of high-dose steroids in a time course that is weakly supported by available data, and encourages further exploration into how the combination of an autoimmune condition and immunosuppressive therapy may influence the risk for reactivation of TB.