Background Invasive fungal infections (IFI) are catastrophic diseases associated with a high mortality. Relatively few cases of IFI have been described in patients with systemic lupus erythematosus (SLE) and their related factors have not been completely understood.
Objectives To evaluate 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 compared with the consecutive 5 hospitalized patients with SLE (controls), thus, demographic factors, evolution time 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. The distribution of causative organisms were as follows: there were four patients infected with Candida spp. (candidemia), three Cryptococcus spp., two Coccidioides immits, one patient with hystoplamosis and one patient with both Aspergillus and Mucor species. A high C-reactive protein (CRP) level was associated with IFI in patients with risk factors, such as: high disease activity, mechanical ventilation, hemodyalisis, hypocomplementemia, high doses of glucocorticoids (GCs) and therapy with mycophenolate mofetil (MMF). Mortality was four times more frequent in patients with IFI than those SLE patients without the deep fungal infection. A high level of CRP was a characteristic of our patients with IFI; we calculated sensitivity and specificity of CRP level of more than 10 mg/dl for diagnosing IFI, we found that it has a sensitivity of 74% and specificity of 70%.
Conclusions IFI is a rare infection observed in SLE patients, it is associated with elevated morbidity and mortality; therefore, its diagnosis and opportune treatment are desirables. We describe risk factors potentially associated with this systemic infectious disease.
Disclosure of Interest None Declared
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