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THU0497 Herpes Zoster Infection in Childhood and Adult Systemic Lupus Erythematosus: Higher Prevalence and Distinct Features
  1. N.W. Gormezano1,
  2. C.A. Silva1,
  3. C.I. Otsuzi2,
  4. D.L. Barros2,
  5. M.A. da Silva2,
  6. A.M. Sallum2,
  7. S. Pasoto2,
  8. R.M. Pereira2,
  9. E. Bonfá2
  1. 1Pediatric Rheumatology Division
  2. 2Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo – SP, Brazil

Abstract

Background Infections are an important cause of morbimortality in childhood-onset systemic lupus erythematosus (cSLE) and adult-onset SLE (aSLE) patients. Herpes zoster infection (HZI) has been the most common viral infection reported for these patients.

Objectives To compare clinical, laboratorial, treatment and outcome parameters in both groups is lacking in the literature.

Methods This retrospective study included 362 cSLE and 1,830 aSLE patients followed in the same tertiary hospital. HZI was defined according to the presence of acute vesicular-bullous lesions on erythematous/edematous base, in a dermatomal distribution. Data concerning the HZI onset, dermatomal involvement and location, treatment, recurrence and complication associated with HZ were determined. Demographic data, clinical features, disease activity (SLEDAI-2K), disease damage (SLICC/ACR-DI) and treatment were also assessed.

Results HZI was significantly more often observed in cSLE vs. aSLE (10% vs. 4%, p=0.0001) and disease duration until HZI diagnosis was also shorter in former group (21 vs. 62 months, p=0.001). At HZI diagnosis, the median of SLEDAI-2K [8 (0-20) vs. 3 (0-18), p=0.002] was higher in cSLE, and fever (43% vs. 12%, p<0.0001), nephritis (45% vs. 25%, p=0.038), anti-dsDNA (76% vs. 15%, p<0.0001) and low C4 (48% vs. 22%, p=0.017) were more often observed when compared to aSLE. A predominance of thoracic dermatomal involvement, with a very low frequency of cutaneous dissemination, ophthalmic complications and recurrence was evidenced in both groups with no deaths. The median prednisone dose was comparable in cSLE and aSLE (20 vs. 20mg/day, p=0.784). Immunosuppressive use was alike in cSLE and aSLE patients, with exception of lower frequency of mycophenolate mofetil in cSLE group (8% vs. 34%, p=0.004). Intravenous acyclovir use (78% vs. 29%, p<0.0001) and hospitalizations due to HZI (78% vs. 29%, p<0.0001) were more often observed in cSLE compared to aSLE. Post herpetic neuralgia was infrequently evidenced in pediatric patients (3% vs. 24%, p=0.005).

Conclusions Pediatric lupus has a higher susceptibility to HZI and it is characterized by a shorter disease duration, disease activity and lower frequency of post herpetic neuralgia than aSLE. Both groups have a comparable and good overall outcome.

Disclosure of Interest N. Gormezano: None declared, C. Silva Grant/research support from: Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPq 302724/2011-7 to CAS), Federico Foundation (to CAS) and by Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP (NAP-CriAd) to CAS., C. Otsuzi: None declared, D. Barros: None declared, M. da Silva: None declared, A. Sallum: None declared, S. Pasoto: None declared, R. Pereira Grant/research support from: Federico Foundation, E. Bonfá Grant/research support from: Federico Foundation

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