SHM Converge Scientific Abstract ePoster Gallery-Unraveling Complexity: Late-Onset Systemic Lupus Erythematosus With Concurrent Tuberculosis Activation

Pdf Summary

This case highlights late-onset systemic lupus erythematosus (SLE), which accounts for fewer than 1 in 5 SLE cases and often presents differently from classic disease. Instead of the more familiar arthritis or malar rash, late-onset SLE more commonly involves serositis and pulmonary manifestations. Because these atypical presentations can fall outside standard diagnostic expectations, avoiding anchoring bias is essential.<br /><br />During the hospital course, CT chest showed a pulmonary infarct in the posterior right lower lobe with early cavitation, along with pleural effusions and left axillary adenopathy. The patient also experienced a rapid shift from latent to active tuberculosis after corticosteroid initiation. This is notable because current guidelines do not require latent TB testing before starting steroids, raising concern that even low-dose, short-term steroid therapy may contribute to TB activation when combined with other risk factors such as advanced age and hypocomplementemia.<br /><br />The case underscores the importance of clinical flexibility and interdisciplinary collaboration when initial assumptions do not fit the evolving picture. It also suggests that screening strategies for TB in patients receiving corticosteroids for autoimmune disease may deserve further discussion, especially in those with additional risk factors.

Asset Subtitle

Jessica R. Glover

Meta Tag

Author List Akriti Jalla, Jessica R. Glover, Omar Bishr

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Late-Onset Systemic Lupus Erythematosus

Concept Latent Tuberculosis

Concept Tuberculosis Reactivation

Concept Anchoring Bias

Distinguished Non-Finalist

Presenter Organization Moffitt Cancer Center

Presenting Author Jessica R. Glover

Track Adult

Keywords

late-onset systemic lupus erythematosus

SLE

serositis

pulmonary manifestations

anchoring bias

pulmonary infarct

pleural effusions

latent tuberculosis

corticosteroid initiation

tuberculosis activation

Systemic Lupus Erythematosus

Late-Onset Systemic Lupus Erythematosus

Latent Tuberculosis

Tuberculosis Reactivation

Anchoring Bias