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Central nervous system infections in Filipino patients with systemic lupus erythematosus
International Journal of Rheumatic Diseases, 08/20/09

Vargas PJ et al. – Study describes the etiology and outcomes of central nervous system (CNS) infections in a group of Filipino patients with systemic lupus erythematosus (SLE). Risk factors included active SLE in the majority of cases requiring moderate to high-dose steroids and other immunosuppressants like cyclophosphamide. Although C. neoformans and M. tuberculosis were the most common etiologic agents, it is just as important to search for less common organisms which can produce disease in highly susceptible hosts.

Methods

This case series describes the etiology, contributing factors and outcomes of CNS infections in SLE pts
Medical records of SLE pts diagnosed and confined for a CNS infection from 1997 to 2007

Results

23 SLE pts (22 females) diagnosed with CNS infection:
- Mean age was 25.8 yrs (range 12–51) at SLE diagnosis, and
- 30.9 yrs (range 14–58) at CNS infection
- Mean disease duration of 55 mo (range 7–125)
82.6% were meningitis, and 17.4% were diagnoses of brain abscess
Etiologic agents identified as:
- Cryptococcus neoformans in 7 (30.4%)
- Mycobacterium tuberculosis in 7 (30.4%)
- Streptococcus pneumoniae in 2 (8.7%)
- Salmonella sp. in 1 (4.4%)
- Corynebacterium bovis with Actinomyces sp. in 1 (4.4%), and
- No isolate in 5 (21.7%)
Average daily prednisone dose was 28.9 mg (range 0–60 mg)
10 pts had recently received pulse cyclophosphamide, and 2 were on mycophenolate mofetil at the time of infection
Most cases had active SLE
The lone patient in disease remission had S. pneumoniae meningitis post-splenectomy
Most common presentation was headache (100%) and fever (87%)
The infection resolved completely in 39.1%, and resolved with sequelae in 8.7%; 52.2% of pts died