TB MDR Primer dengan Limfadenitis TB pada Wanita SLE

[Primary Multidrug-Resistant Tuberculosis Mixed with Lymphadenitis Tuberculosis in a Woman with SLE]

Background: Primary resistance is the resistance that occurs in patients who have never received treatment OAT or had ever received  treatment OAT is less than 1 month. The incidence of primary MDR in Central Java in 2006 2.07%. Extrapulmonary TB about 15-20%  of all cases of TB, and TB lymphadenitis is the highest form (35% of all extrapulmonary TB). Patients with decreased immune systems  (SLE) can increase the incidence of TB. Research in Spain get 6x higher TB incidence in patients with SLE. Case: We present the case  of 19 year old woman SLE who received treatment for 11 months whose came with shortness of breath and chronic cough since 2 month  prior to admission. In physical examination we found right and left submandibula lymphonodi enlargement as solid, slightly mobile  nodule with diameter 3 cm. Chest X ray showed lung inflammation which suspicion of specific process and minimal left pleural effusion,  and concluded as pulmonary TB. FNAB confirmed lymphadenitis TB with granulomatous inflammation. One of AFB result is positive  and Gene Xpert is MTB positive with rifampicin resistant that make this patient categorized as primary MDR TB with lymphadenitis  TB. This patient received Pirazinamid 1500 mg, Ethambutol 800 mg, Kanamicin 750 mg, Levofloxacin 750 mg, Ethionamide 500 mg,  Cicloserin 500 mg, and B6 100 mg. Conclusion: MDR TB in general occur in patients with a history of OAT previous TB (MDR TB  secondary). Primary MDR TB with lymphadenitis tb is a rare case, but can occur on the condition that decreases the immune system,  one of SLE. This involves multiple immune disorders caused by the use of long-term immunosuppressive therapy.