Invasive fungal infections in patients with systemic lupus erythematosus
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Objective. Invasive fungal infections (IFI) are catastrophic diseases associated with a high mortality. Relatively few cases of IFI have been described in systemic lupus erythematosus (SLE) and their related factors have not been completely explored. We evaluated factors associated with IFI in patients with SLE. Methods. All patients with both IFI and SLE admitted to our hospital in the last 7 years were evaluated and each was compared with 5 hospitalized patients with SLE (controls). Demographic factors, duration of SLE, and treatment in the previous month were compared. Results. Sixty patients with SLE were evaluated (10 with IFI and 50 controls). Median age was 29 years. High C-reactive protein levels were associated with IFI, along with other factors such as high disease activity, mechanical ventilation, treatment with antibiotics, hemodialysis, high doses of glucocorticoids (GC), and treatment with mycophenolate mofetil. Mortality was 4 times more frequent in patients with IFI than in SLE patients without the deep fungal infection. Conclusion. IFI is a rare infection observed in patients with rheumatic diseases. We describe factors associated with IFI in patients with SLE. IFI is associated with elevated morbidity and mortality. Early diagnosis and treatment are desirable. The Journal of Rheumatology Copyright © 2012. All rights reserved.
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Infections; Invasive fungal infections; Systemic lupus erythematosus amphotericin B; amphotericin B lipid complex; anidulafungin; antibiotic agent; azathioprine; C reactive protein; cyclophosphamide; glucocorticoid; methotrexate; methylprednisolone; mycophenolic acid 2 morpholinoethyl ester; prednisone; rituximab; adolescent; adult; antibiotic therapy; article; artificial ventilation; Aspergillus; blood culture; Candida; case control study; clinical article; Coccidioides immitis; comparative study; controlled study; Cryptococcus; demography; disease activity; disease duration; dose response; drug megadose; drug pulse therapy; female; hemodialysis; Histoplasma capsulatum; hospital admission; human; immunosuppressive treatment; infection risk; male; mortality; Mucor; priority journal; protein blood level; protein function; retrospective study; risk assessment; systemic lupus erythematosus; systemic mycosis; trend study; Adult; Antifungal Agents; C-Reactive Protein; Female; Glucocorticoids; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Mycoses; Risk Factors; Severity of Illness Index
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