Sial F, Basit A, Ghafoor N, Sial W, Basil AM. Mixed connective tissue disease and tuberculosis coexistence as a diagnostic dilemma: A case report. World J Clin Cases 2025; 13(33): 109866 [PMID: 41356082 DOI: 10.12998/wjcc.v13.i33.109866]
Corresponding Author of This Article
Abdul M Basil, MD, Department of Medicine, Spinghar Medical University, 4th Alley, Char Rahe Qambar Kabul, Kabul 1001, Kābul, Afghanistan. abdulmaboodbasil@outlook.com
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 26, 2025 (publication date) through Jan 9, 2026
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World Journal of Clinical Cases
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Sial F, Basit A, Ghafoor N, Sial W, Basil AM. Mixed connective tissue disease and tuberculosis coexistence as a diagnostic dilemma: A case report. World J Clin Cases 2025; 13(33): 109866 [PMID: 41356082 DOI: 10.12998/wjcc.v13.i33.109866]
World J Clin Cases. Nov 26, 2025; 13(33): 109866 Published online Nov 26, 2025. doi: 10.12998/wjcc.v13.i33.109866
Mixed connective tissue disease and tuberculosis coexistence as a diagnostic dilemma: A case report
Fatima Sial, Abdul Basit, Nabeela Ghafoor, Warda Sial, Abdul M Basil
Fatima Sial, Abdul Basit, Nabeela Ghafoor, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Warda Sial, Department of Medicine, CMH Lahore Medical College, Lahore 54000, Punjab, Pakistan
Abdul M Basil, Department of Medicine, Spinghar Medical University, Kabul 1001, Kābul, Afghanistan
Co-first authors: Fatima Sial and Abdul Basit.
Author contributions: Sial F contributed to conception, have agreed both to be personally accountable for the accuracy and integrity of the work; Sial F, Basit A, Ghafoor N, Sial W, Basil AM contributed to interpretation of data, have drafted the work, approved the submitted version; Basit A, Ghafoor N, Sial W, Basil AM have agreed to be personally accountable for the accuracy and integrity of the work.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this article. No financial support, grants, or funding was received from any organization for the submitted work. The authors have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdul M Basil, MD, Department of Medicine, Spinghar Medical University, 4th Alley, Char Rahe Qambar Kabul, Kabul 1001, Kābul, Afghanistan. abdulmaboodbasil@outlook.com
Received: May 26, 2025 Revised: June 2, 2025 Accepted: October 28, 2025 Published online: November 26, 2025 Processing time: 181 Days and 15.5 Hours
Abstract
BACKGROUND
Mixed connective tissue disease (MCTD) is a rare autoimmune disorder characterized by overlapping features of systemic lupus erythematosus, systemic sclerosis, and polymyositis, and presence of anti-U1 ribonucleoprotein antibodies. Coexistence with tuberculosis (TB), a common infectious disease in endemic areas, poses a significant diagnostic challenge due to overlapping clinical and radiological features.
CASE SUMMARY
We report a 35-year-old Pakistani female presenting with oral ulcers, body rash, worsening dyspnea, and a history of joint pains initially treated as rheumatoid arthritis. She was on antituberculous therapy (ATT) for presumed pulmonary TB. Laboratory findings revealed anemia, leukopenia, raised erythrocyte sedimentation rate, positive anti-Sm/RNP, anti-dsDNA, and anti-SSA/Ro antibodies, confirming MCTD with clinical features of systemic lupus erythematosus, Sjogren syndrome, and systemic sclerosis. The patient was also positive for hepatitis C and active TB. Treatment involved corticosteroids alongside continuation of ATT, resulting in significant clinical improvement over 12 days, with resolution of symptoms and improved laboratory parameters. The patient remained stable on follow-up with hydroxychloroquine and prednisolone.
CONCLUSION
This case highlights the diagnostic complexity when autoimmune diseases coexist with TB, particularly in TB-endemic regions. Early recognition and integrated management of both conditions are crucial to improving outcomes. Clinicians should maintain a broad differential diagnosis and perform comprehensive immunological workup in patients with overlapping symptoms.
Core Tip: Mixed connective tissue disease (MCTD) can mimic infectious diseases like tuberculosis (TB), complicating diagnosis especially in TB-endemic regions. This case highlights the importance of comprehensive immunological testing to differentiate MCTD from TB. Early recognition and tailored treatment improve patient outcomes significantly.
