# Pulmonary Tuberculosis Complicating Interstitial Lung Disease in Systemic Sclerosis: A Case Report from a High TB Burden Country

## TL;DR

A woman with systemic sclerosis and lung disease developed tuberculosis, highlighting the need for careful management in high TB areas.

## Contribution

This case report adds to the understanding of managing tuberculosis in systemic sclerosis patients with interstitial lung disease in TB-endemic regions.

## Key findings

- The patient had systemic sclerosis-associated interstitial lung disease confirmed by clinical and imaging findings.
- Pulmonary tuberculosis was diagnosed through acid-fast bacilli smear and GeneXpert testing during treatment.
- Coordinated care among specialists is essential for managing complex cases like this.

## Abstract

Systemic sclerosis (SSc) is a chronic connective tissue disease marked by immune system dysfunction, vascular damage, and progressing fibrosis involving the skin and various internal organs. Interstitial lung disease (ILD) represents one of the leading contributors to illness and death in patients with SSc. The management becomes more complex when complicated by opportunistic infections such as tuberculosis (TB), particularly in endemic regions. We present the case of a 45-year-old woman with complaints of generalized weakness for one-week, intermittent fever, nausea and vomiting, and a weight loss of 5 kg over the previous 2 months. Clinical examination showed skin thickening and sclerodactyly, which then diagnosed as SSc-associated ILD (SSc-ILD). High-resolution computed tomography (HRCT) revealed reticular changes, ground-glass opacities, and traction bronchiectasis, indicating a nonspecific interstitial pneumonia (NSIP) pattern. During the course of treatment, the patient developed a persistent productive cough, weight loss, and fever. Pulmonary TB was confirmed through acid-fast bacilli smear and GeneXpert testing. Early recognition of dual pathology and coordinated care among rheumatology, pulmonology, and infectious disease teams are crucial for optimizing outcomes. This case underlines the need for vigilance in managing immunosuppressed patients in TB-endemic settings and contributes to the literature on SSc-ILD complicated by active TB.