一例人类免疫缺陷病毒阳性合并继发性肺结核与系统性红斑狼疮病例分析

A Case Analysis of Human Immunodeficiency Virus Positive Complicated with Secondary Pulmonary Tuberculosis and Systemic Lupus Erythematosus

摘要: 本文报告一例44岁女性人类免疫缺陷病毒(HIV)阳性患者合并继发性肺结核与系统性红斑狼疮(SLE)的诊疗过程。患者以发热、咳嗽、腹泻、神经精神症状起病，经实验室、影像学及免疫学检查，符合2019年ACR/EULAR的SLE分类标准(积分34分)，诊断为HIV感染合并SLE (重度活动)，同时根据临床表现及免疫学证据高度怀疑继发性肺结核。经抗病毒、抗结核、糖皮质激素冲击、贝利尤单抗及支持治疗后，患者病情好转。本病例揭示了HIV、结核与SLE三者共存时的诊断与治疗挑战，提示临床需警惕免疫缺陷背景下感染与自身免疫病重叠时可能出现的复杂临床进程。

Abstract: This article reports the diagnosis and treatment process of a 44-year-old female patient with human immunodeficiency virus (HIV) positivity complicated with secondary pulmonary tuberculosis and systemic lupus erythematosus (SLE). The patient presented with fever, cough, diarrhea, and neuropsychiatric symptoms. Laboratory, imaging, and immunological examinations met the 2019 ACR/EULAR classification criteria for SLE (score 34 points), leading to a diagnosis of HIV infection combined with SLE (severely active). Secondary pulmonary tuberculosis was highly suspected based on clinical manifestations and immunological evidence. After treatment with antiretroviral therapy, anti-tuberculosis therapy, glucocorticoid pulse therapy, belimumab, and supportive care, the patient’s condition improved. This case highlights the diagnostic and therapeutic challenges of the coexistence of HIV, tuberculosis, and SLE, suggesting that clinicians should be vigilant about the complex clinical course that may occur when infections and autoimmune diseases overlap in an immunocompromised background.