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Invasive aspergillosis in systemic lupus erythematosus
M R Gonzalez-Crespo1, J J Gomez-Reino
1Rheumatology Unit, Hospital Doce de Octubre, Madrid, Spain.
Seminars in Arthritis and Rheumatism
|April 1, 1995
Summary
Invasive aspergillosis is rare in systemic lupus erythematosus (SLE) patients, often presenting with fever and cough. Early diagnosis via tissue biopsy and prompt antifungal treatment are crucial for survival, as mortality is high.
Area of Science:
- Infectious Diseases
- Rheumatology
- Pulmonology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse clinical manifestations.
- Invasive aspergillosis is a serious fungal infection, typically seen in immunocompromised individuals.
- The co-occurrence of invasive aspergillosis and SLE is infrequently reported.
Observation:
- This study reviews two cases of invasive aspergillosis in SLE patients and analyzes 21 previously reported cases (1957-1994).
- Common symptoms included fever and cough in hospitalized SLE patients undergoing treatment with corticosteroids, immunosuppressors, and broad-spectrum antibiotics.
- Granulocytopenia, a frequent finding in other aspergillosis cases, was uncommon in this SLE cohort.
Findings:
- Chest radiographs typically revealed diffuse or patchy pulmonary infiltrates.
- Diagnosis was suspected premortem in only two patients.
- Aspergillus fumigatus was the most common pathogen, identified in sputum or lung tissues. The overall mortality rate was 95%.
Implications:
- Prompt diagnosis of invasive aspergillosis in SLE patients requires a high index of suspicion, especially with suggestive symptoms and imaging.
- Diagnostic procedures should include bronchoscopy, bronchoalveolar lavage, and lung biopsy for definitive identification of fungal hyphae and culture.
- Aggressive antifungal therapy, potentially including amphotericin B, fluorocytosine, or itraconazole, may improve patient outcomes.