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[A case of diffuse panbronchiolitis with SLE complicated by fungal infection]
1Department of Pediatrics, Kashiwa Hospital, Tokyo Jikei University School of Medicines.
Abstract:
We report a patient who developed SLE during the course of diffuse panbronchiolitis (DPB) and had candidiasis later. The patient fulfilled the criteria for diagnosis of SLE after appearance of fever and general peripheral arthritis. Regarding serum virus antibody values at the time of SLE diagnosis, IgG and IgM of human Parvovirus B19 (B19) were positive by the EIA test and also by the serum PCR test. For continuously Pseudomonas aeruginozae in sputum cultures because of existing DPB, immunosuppressasnt therapy with prednisolone and mizoribine was given while suppressing proliferation of bacterial infections with antibiotics. As a result, the intensity of SLE decreased smoothly. About 1 month after beginning of the treatment, the chest X-ray revealed infiltrative densities in the lingual area of the left lobule and in S3 of the right lobule. Judging from the clinical course and various examination findings, concurrence of candidiasis was suspected. Fungal infection in this patient was progressive, so various antifungal agents were used concurrently. Furthermore, immunoglobulin therapy was supplemented while determining serum immunoglobulin levels, and doses of prednisolone and mizoribine were reduced rapidly. Afterward the patient followed a satisfactory clinical course. About 2 years later SLE recurred, aspergillosis developed concurrently and the disease progressed rapidly to its termination. DPB itself is difficult to control and often complicated with various diseases. Therefore, immunosuppresant therapy for complications is sometimes used in addition to the treatment of DPB. More careful observations on the clinical course are necessary in dealing with this disease.
Insights
A patient developed Systemic Lupus Erythematosus (SLE) during diffuse panbronchiolitis (DPB), complicated by Parvovirus B19 infection and later candidiasis. Immunosuppressive therapy improved SLE, but recurrence with aspergillosis led to a fatal outcome.
Area of Science:
- Immunology
- Pulmonology
- Infectious Diseases
Background:
- Diffuse panbronchiolitis (DPB) is a chronic inflammatory lung disease often associated with secondary infections.
- Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
- Co-occurrence of DPB and SLE presents unique diagnostic and therapeutic challenges.
Observation:
- A patient with pre-existing DPB developed SLE, characterized by fever and arthritis.
- Human Parvovirus B19 (B19) infection was identified as a potential trigger or co-factor for SLE development.
- The patient experienced opportunistic infections, including candidiasis and later aspergillosis, during immunosuppressive therapy.
Findings:
- Immunosuppressive treatment with prednisolone and mizoribine initially reduced SLE activity.
- Progressive fungal infections (candidiasis, aspergillosis) complicated the patient's course, requiring extensive antifungal and immunoglobulin therapy.
- Recurrence of SLE, concurrent with invasive aspergillosis, ultimately led to a rapid and fatal progression of the disease.
Implications:
- This case highlights the complex interplay between DPB, autoimmune diseases like SLE, and opportunistic infections.
- Careful monitoring and management of immunosuppression are crucial in patients with overlapping conditions.
- Further research is needed to understand the pathogenesis and optimize treatment strategies for such complex cases.