Tuberculosis a mimicker, masquerader and response modifer to autoimmune diseases

Introducton: Globally almost a quarter of populaton has latent tuberculosis and 6-8% has autoimmune diseases. Overlap between these two conditons may present with various clinical pathology. Cases: A 42-year home maker with polyarthrits, raised ESR/CRP, HLAB27 positve and grade I bilateral sacroilits (SI) on X-ray pelvis on high dose steroid and methotrexate was planned for TNF blockers against recurrent then refractory lef sided uveits. One month rifampicin and isoniazid for her Monteux and IGRA positve latent TB relived her uveits and she was prospectvely diagnosed as tubercular uveits and competed ATT course. Actve tuberculosis can mimic HLAB27 syndrome (uveits, peripheral arthrits) due to high prevalence of latent tuberculosis and asymptomatc HLAB27 positve in community. A 36-year businessman diagnosed case of HLAB27 positve Spondyloarthrits was previously treated for latent tuberculosis on adalimumab under remission presented with right knee arthrits with ESR 141mm and CRP109U/mL.Synovial tapping revealed infammatory arthrits and patent was changed to eternacept with additon NSAIDS and methotrexate. He worsen with calf myosits not responding to broad spectrum antbiotc. A trial of ATT drug was initated and he started to respond by the end of a week. He contnued intensive phase for two months followed by eight months contnuous phase of ATT regime. Post ATT his spondyloarthrits is under remission with sulfasalazine. In our case, latent tuberculosis treatment did not prevent the reactvaton of tuberculosis. Discussion: Clinical judgment on manifestaton that mimics tubercular or autoimmune diseases is tough. In high latent tuberculosis geography trial of ant-tubercular for at least month followed by assessment of autoimmune disease could answers such dilemma unless we have a test to diferentate between latent and actve tuberculosis. Conclusion: A clear afordable guideline regarding investgaton and treatment of latent tuberculosis does not exist for rheumatologic patents at developing world.