Invasive aspergillosis: a severe infection in juvenile systemic lupus erythematosus patients
Silva MF et al. – This was the first report that evaluated the prevalence of invasive aspergillosis (IA) in a large population of juvenile systemic lupus erythematosus (JSLE) patients from a tertiary pediatric hospital, and clearly showed the severity of the outcome, especially in patients with active disease and treated with immunosuppressive agents. This study reinforces the importance of early diagnosis and treatment with certain antifungals, especially in critically ill patients.Methods
- From 1983 to 2011, 5604 patients were followed at the institution and 283 (5%) met the American College of Rheumatology (ACR) classification criteria for SLE.
- Six (2.1%) of the JSLE patients had IA.
- One of them was previously reported and five will be described herein.
- Four of them were female.
- The median age at JSLE diagnosis was 12 years (8–16) and the median interval between diagnosis of JSLE and IA was 6 months (1–38).
- All had pulmonary involvement and three of them had systemic involvement.
- The median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI–2K) was 19 (7–22).
- Diagnosis of IA was performed by isolation of Aspergillus spp., two in bronchoalveolar lavage culture and by way of autopsy in the others.
- All of them were treated with corticosteroids and/or immunosuppressive drugs at IA diagnosis (azathioprine and/or intravenous cyclophosphamide).
- They all required treatment in the pediatric intensive care unit with mechanical ventilation and antifungal therapy (fluconazole, amphotericin B, itraconazole and/or voriconazole); nonetheless, none of them survived.