Risk of herpes zoster in patients with systemic lupus erythematosus: a three-year follow-up study using a nationwide population-based cohort

Chen, Hsin‐Hua; Chen, Yi Ming; Chen, Tzeng Ji; Lan, Joung Liang; Lin, Ching Heng; Chen, Der Yuan

doi:10.1590/s1807-59322011000700009

Cited by 50 publications

(46 citation statements)

References 19 publications

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“…The majority of patients show a typical distribution and a good response to treatment. Nevertheless, complications such as secondary bacterial infection and post herpetic neuralgia could be present [1][2][3].…”

Section: Sirmentioning

confidence: 99%

“…In SLE patients is significantly higher reaching 16-22/1000 annually. It is to be noticed that is associated with abnormal cytotoxicity mediated by T cells and aggravated by treatment with corticoids and immunosuppressant [1,2,4,5]. Infection risk factors in patients with SLE in Table I.…”

Section: Incidencementioning

confidence: 99%

“…The drugs above mentioned shall be maintained for 7-10 days and for 2 days after all the lesions are covered by a crust (Tabl. 3) [1][2][3][4].…”

Section: Treatmentmentioning

confidence: 99%

“…severe symptoms, immunosuppression, significant bacterial super infection, disseminated herpes zoster, ophthalmic involvement or meningoencephalopathy involvement [1][2][3][4]6,7].…”

Section: Treatmentmentioning

confidence: 99%

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Herpes zoster in patients with systemic lupus erythematosus

Leroux¹

2016

Our Dermatol Online

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Section: Sirmentioning

confidence: 99%

Section: Incidencementioning

confidence: 99%

“…The drugs above mentioned shall be maintained for 7-10 days and for 2 days after all the lesions are covered by a crust (Tabl. 3) [1][2][3][4].…”

Section: Treatmentmentioning

confidence: 99%

“…severe symptoms, immunosuppression, significant bacterial super infection, disseminated herpes zoster, ophthalmic involvement or meningoencephalopathy involvement [1][2][3][4]6,7].…”

Section: Treatmentmentioning

confidence: 99%

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Herpes zoster in patients with systemic lupus erythematosus

Leroux¹

2016

Our Dermatol Online

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“…Literature describes that patients develop HZ as a complication of SLE. Hsin-Hua Chen et al, reported increased incidence of Herpes in SLE [8]. Kahl LE et al, also reported increased frequency of HZ in SLE patients as compared to general population with risk being increasing with severity of disease [1].…”

mentioning

confidence: 99%

Herpes Zoster as the Presenting Manifestation of Systemic Lupus Erythematosus (SLE): A Rare Case Report

Qureshi

Chaudhury

2016

JCDR

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A 38-year-old female presented with breathlessness on exertion for one month which was neither associated with orthopnoea nor with paroxysmal nocturnal dyspnea. She also had complains of abdominal pain since 20 days localized to periumblical region with radiation to right iliac fossa. Pain was unrelated to food intake but was associated with nausea and vomiting. There was history of nonprogressive dysphagia to both solids and liquids for last 20 days. However, there was no odynophagia. She had developed painful vesicular rash on right half of abdomen four days prior to hospitalization. There was no past history or family history of appearance of vesicular lesions. There was history of oligomenorrhea & fetal death at 21/2 months of gestation. There was no history of substance abuse. On general physical examination her blood pressure was 150/90 mmHg, pulse rate-92/min, regular. She looked pale. Dermatologic examination revealed presence of painful erythaematous vesicular bullous lesions on right side from 8 th thoracic nerve to 10 th thoracic nerve segments. Systemic examination revealed non tender hepatomegaly of 4-5cm. There was no splenomegaly or free fluid in the abdomen. Rest of the physical examination was unremarkable. During hospital stay patient had progressive oliguria.On admission routine investigation revealed leukocytosis (TLC-12×10 3 /µL), thrombocytopaenia (Platelets-75,000/µL) and normal haemoglobin (Hb-13gm/dl) but later on she developed anaemia (Hb-8gm/dl) and leukopaenia (TLC-1.2×10 3 /µL). Kidney function test showed evidence of azotaemia (Blood urea-168, S.creat-3mg %). Electrolytes were deranged, hyponatraemia, normokalaemia were present initially followed by hyperkalaemia (K-5.5meq/l) later on, hypocalcaemia (7.7mg/dl) and hyperphosphataemia (5 meq/l) were also present. Urine examination revealed albuminuria with 24 hour urinary protein excretion being 1515 mg/24 h. Other routine investigations e.g. liver function tests, Arterial blood gases, Chest X-ray PA view, electrocardiogram, etc. didn't show any abnormality. Special investigations were carried out including immunological tests e.g. Direct coombs test -positive, Antinuclear antigen -positive (2+), dsDNA-27/IU (Positive), SSA/RO60 (4+), RO52 (3+) and TSH was increased (30.40mIU/L). She underwent Kidney biopsy in view of significant proteinuria associated with ANA and dsDNA positivity, which revealed diffuse lupus nephritis (WHO Class IV). Thus a final diagnosis of primary hypothyroidism, systemic lupus, lupus nephritis with herpes zoster was made. Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease and is usually diagnosed with the SLICC criteria. Here we report a case of SLE presenting as Herpes Zoster (HZ). She had presented with painful vesicular eruptions from 8 th thoracic nerve to 10 th thoracic nerve segments and oliguria. There were no clinical manifestations suggestive of SLE. However, on further workup, haematological and immunologic laboratory profiles were suggestive of SLE. A diagnosis of lupus nephropathy wa...

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Altered Cellular and Humoral Immunity to Varicella‐Zoster Virus in Patients With Autoimmune Diseases

Rondaan

Haan

Horst

et al. 2014

Arthritis & Rheumatology

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Objective. Patients with autoimmune diseases such as systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (Wegener's) (GPA) have a 3-20-fold increased risk of herpes zoster compared to the general population. The aim of this study was to evaluate if susceptibility is due to decreased levels of cellular and/or humoral immunity to the varicellazoster virus (VZV).Methods. A cross-sectional study of VZV-specific immunity was performed in 38 SLE patients, 33 GPA patients, and 51 healthy controls. Levels of IgG and IgM antibodies to VZV were measured using an in-house glycoprotein enzyme-linked immunosorbent assay (ELISA). Cellular responses to VZV were determined by interferon-␥ (IFN␥) enzyme-linked immunospot (ELISpot) assay and carboxyfluorescein succinimidyl ester (CFSE) dye dilution proliferation assay.Results. Levels of IgG antibodies to VZV were increased in SLE patients as compared to healthy controls, but levels of IgM antibodies to VZV were not. Antibody levels in GPA patients did not differ significantly from levels in healthy controls. In response to stimulation with VZV, decreased numbers of IFN␥ spot-forming cells were found among SLE patients (although not GPA patients) as compared to healthy controls. Proliferation of CD4؉ T cells in response to stimulation with VZV was decreased in SLE patients but not GPA patients.Conclusion. SLE patients have increased levels of IgG antibodies against VZV, while cellular immunity is decreased. In GPA patients, antibody levels as well as cellular responses to VZV were comparable to those in healthy controls. These data suggest that increased prevalence of herpes zoster in SLE patients is due to a poor cellular response. Vaccination strategies should aim to boost cellular immunity against VZV.Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus (VZV) (1,2). It presents as an acute neurocutaneous disease characterized by severe pain and rash in a dermatomal distribution (3). Postherpetic neuralgia, defined as pain lasting Ͼ90 days after onset of rash, is the most common complication of herpes zoster and is estimated to occur in 8-27% of patients (4-7). Herpes zoster and postherpetic neuralgia can have a major impact on quality of life and productivity of a patient (4,5). In particular, elderly individuals and individuals with compromised immune systems are at increased risk of developing herpes zoster and, accordingly, postherpetic neuralgia (3,6).Systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (Wegener's) (GPA) both are autoimmune inflammatory rheumatic diseases. Patients with an autoimmune inflammatory rheumatic disease are at increased risk of infections including herpes zoster, as a result of the immunosuppressive effect of the disease and/or the use of immunomodulatory medication (8-10). Herpes zoster is found in 15-91 cases per 1,000 patient-years among SLE patients and 45 cases per 1,000 patient-years among GPA patients (3,11,12). Since the incidence of herpes zoster in developed countries is...

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Risk of herpes zoster in patients with systemic lupus erythematosus: a three-year follow-up study using a nationwide population-based cohort

Cited by 50 publications

References 19 publications

Herpes zoster in patients with systemic lupus erythematosus

Herpes zoster in patients with systemic lupus erythematosus

Herpes Zoster as the Presenting Manifestation of Systemic Lupus Erythematosus (SLE): A Rare Case Report

Altered Cellular and Humoral Immunity to Varicella‐Zoster Virus in Patients With Autoimmune Diseases

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