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Catarina Perez Brandão1; Catarina Gouveia1; Rodrigo Carvalho2; Marta Conde3; Luís Varandas1

1 - Unidade de Infecciologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
2 - Serviço de Dermatologia, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
3 - Unidade de Reumatologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa

7th Europaediatrics Congress, Florença, 13-16 de Maio de 2015 (Poster)

INTRODUCTION: Tuberculosis (TB) is a global health problem and Africa scores the majority of the cases. The lung is the most commonly affected organ in TB and the lymph nodes are the most common site of extra-pulmonary involvement. Systemic lupus erythematosus (SLE) is a common systemic autoimmune connective tissue disorder in children and the acute cutaneous component correlates with disease activity. Chronic forms (discoid lesions) are rare in children and besides the lack of knowledge about disease progression to SLE, they do not correlate with disease activity.
CASE REPORT: A 14-year-old girl from Guinea-Bissau was observed at Hospital Dona Estefânia, Lisbon, with a 6-month history of recurrent low-grade fever, poor appetite and weight loss (11%). At admission she presented with several scaly skin lesions on her face, ears and arms as well as multiple, bilateral, cervical and supraclavicular lymphadenopathies. Ganglionar TB was considered based on positives tuberculin skin and IGRA test, positive Mycobacterium tuberculosis culture on gastric aspirate and lymph node biopsy, and a granulomatous lymphadenitis in a supraclavicular limph node. Skin biopsy results were unspecific and negative for TB. She received isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months, followed by 4 months of isoniazid and rifampicin. Since her skin lesions did not resolve a second skin biopsy was made being consistent with discoid lupus erythematosus (DLE), with no laboratory evidence of systemic autoimmune disease.
DISCUSSION: Both pulmonary and extra-pulmonary forms of TB have a good outcome when treatment regimen is strictly followed. There is no evidence of an association between TB and DLE. DLE might be associated with SLE and children require monitoring for systemic disease.

PALAVRAS-CHAVE: pulmonary tuberculosis; extrapulmonary tuberculosis; discoid lupus erythematosus