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Mucormycosis in systemic lupus erythematosus
Chi Chiu Mok1, Tak Lun Que, Edmund Yik Kong Tsui
1Departments of Medicine, Microbiology, Radiology, and Pathology, Tuen Mun Hospital, Hong Kong, China. ccmok@netvigator.com
Seminars in Arthritis and Rheumatism
|November 20, 2003
Summary
Mucormycosis is a rare, often fatal fungal infection in patients with systemic lupus erythematosus (SLE). Early diagnosis and combined treatment are crucial for improving outcomes in this high-risk group.
Area of Science:
- Medical Mycology
- Rheumatology
- Infectious Diseases
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease often managed with immunosuppressive therapy.
- Opportunistic infections, such as mucormycosis, pose a significant risk to SLE patients.
Observation:
- This review analyzed eight cases of mucormycosis in SLE patients reported between 1970 and 2002.
- Patients were typically young females with active SLE, often on high-dose corticosteroids and sometimes cytotoxic agents.
- Predisposing factors included hypocomplementemia, nephrotic syndrome, uremia, leukopenia, and diabetes mellitus.
Findings:
- Disseminated mucormycosis was the most common presentation, frequently diagnosed post-mortem (63%).
- Rhizopus species were identified in culture-positive cases.
- The overall mortality rate was high at 88%, often due to delayed diagnosis and treatment.
- Fungal infection symptoms sometimes mimicked active SLE.
Implications:
- Mucormycosis in SLE is rare but carries a high mortality rate.
- A high index of suspicion, prompt diagnosis, and aggressive treatment (amphotericin B plus surgical debridement) are vital.
- Judicious use of immunosuppressive agents may help mitigate risk.