Tuberculosis in adult patients with sickle cell disease

Although infection, in particular pulmonary infection, is a common complication of sickle cell disease (SCD) and although SCD is frequent in populations where the prevalence of tuberculosis is high, the relationship between the two diseases has never been studied. We conducted a study to assess the epidemiological and clinical pattern of tuberculosis in adult patients with SCD.

We retrospectively reviewed the cases of tuberculosis reported within our cohort of 457 SCD patients from January 1998 to April 2006 in the adult sickle cell center of Hôpital Tenon, Paris, France.

We identified 12 cases of tuberculosis, 8 men and 4 women. There were 7 lymph node lesions, 3 pulmonary lesions and 2 vertebral lesions. The incidence of pulmonary and extrapulmonary tuberculosis was respectively of 82 and 246 cases per 100,000, to compare with an expected incidence of 184 cases, and 65 cases per 100,000. Three of the patients with lymph node tuberculosis were asymptomatic. No case of multi-organ involvement was seen. No other cause of immunodepression than the functional asplenia was found. All the patients showed clinical improvement under treatment.

In SCD patients, lymph node tuberculosis appears to have a higher incidence than that in an epidemiologically comparable population, and has a rather indolent presentation and a favourable outcome. Pulmonary tuberculosis seems to be less frequent than expected.