Risk factors for major infections in Wegener granulomatosis: analysis of 113 patients
C Charlier1, C Henegar, O Launay
1Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes, Faculté de Medicine, UPRES EA 4058, Assistance Publique-Hôpitaux de Paris, Paris Cedex 14, France.
Objective:
To characterise major infectious complications and analyse potential risk factors in patients with Wegener granulomatosis (WG).
Methods:
Data from 113 patients with WG (69 male) followed at least once between January 1984 and March 2006 in our internal medicine department, were analysed retrospectively.
Results:
A total of 35 patients (mean (SD) age at WG diagnosis: 50.2 (13.05) years) developed 53 major infections. Infections were: bronchopneumonias (n = 19), herpes zoster recurrences (n = 9), cellulitis (n = 4), prostatitis (n = 4), spondylodiscitis and septic arthritis (n = 3), digestive tract infections (n = 2), Enterococcus faecalis or Staphylococcus aureus septicaemia (n = 2), viral hepatitis B reactivations (n = 2), post transfusion HIV infection with fatal cerebral toxoplasmosis, oesophageal candidiasis, disseminated herpes simplex and cytomegalovirus infection, cytomegalovirus retinitis, herpetic keratitis, herpetic stomatitis, Serratia sp. node suppuration and fever resolving under broad spectrum antibiotics (n = 1 each). Half of the major infectious episodes occurred within 3 years after WG diagnosis. Eight (7%) patients died, with two (2%) infection-related deaths. Patients diagnosed with WG before 1996 had a significantly higher rate of infection than those diagnosed later (48% vs 24%, p = 0.02). Cyclophosphamide and corticosteroids were independently associated with significantly higher risk of major infection (p<0.05 and <0.001, respectively). All patients treated since 1993 received antipneumocystosis prophylaxis.
Conclusion:
Cyclophosphamide and corticosteroids were associated with higher risk of infection. Despite systematic cotrimoxazole prophylaxis, major infections, mostly bronchopneumonias and herpes zoster recurrences, were still common in the course of WG.
Insights
Wegener granulomatosis (WG) patients treated with cyclophosphamide and corticosteroids face a higher risk of major infections like bronchopneumonia and herpes zoster. Prophylaxis helps, but infections remain common in WG management.
Area of Science:
- Rheumatology
- Infectious Diseases
- Clinical Medicine
Background:
- Wegener granulomatosis (WG), now known as Granulomatosis with Polyangiitis, is a systemic vasculitis.
- Infectious complications are a significant concern in WG patients, potentially influenced by disease activity and immunosuppressive treatments.
Purpose of the Study:
- To characterize major infectious complications in patients diagnosed with Wegener granulomatosis.
- To identify potential risk factors associated with these infections, particularly in relation to treatment regimens.
Main Methods:
- Retrospective analysis of data from 113 patients with WG followed between 1984 and 2006.
- Detailed review of infectious episodes, patient demographics, diagnosis dates, and treatment protocols, including immunosuppressants and prophylaxis.
Main Results:
- 35 patients (31%) developed 53 major infections, with bronchopneumonias and herpes zoster recurrences being most frequent.
- Infections were more common in patients diagnosed before 1996. Cyclophosphamide and corticosteroids were independently associated with a significantly higher risk of major infection.
- Half of the infections occurred within 3 years of WG diagnosis; 7% of patients died, with 2% due to infection.
Conclusions:
- Cyclophosphamide and corticosteroids are significant risk factors for major infections in WG patients.
- Despite antipneumocystosis prophylaxis (cotrimoxazole), major infections, particularly bronchopneumonias and herpes zoster, remain a considerable challenge in the management of WG.
