THU0189 Invasive fungal infections in patients with systemic lupus erythematosus:

Abstract

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%. Table 1. Main characteristics at admission of patients included in the study Patients with IFI (n=10)Controls (n=50)All (n=60)p Age30 (16, 51)28 (12, 54)29 (12,54)0.592 Female n (%)7 (70)41 (82)48 (80)0.403 Evolution of SLE (months)27 (0, 240)13.5 (0, 192)16.5 (0, 240)0.212 Leukocytes ×103/μL4.1 (1.9, 20.7)7.2 (0.1, 17.3)6.3 (0.1, 20.7)0.059 Lymphocytes ×103/μL0.44 (0.04, 1.8)0.73 (0.02, 2.79)0.68 (0.02, 2.79)0.061 Creatinine mg/dl2.8 (0.5, 8.1)0.9 (0.4, 11.7)1.1 (0.4, 11.7)0.190 Albumin g/dl2.9 (0.6, 3.5)3.0 (1.2, 6.2)2.9 (0.6, 6.2)0.147 CRP mg/dl16.3 (0.6, 30.5)1.3 (0.01, 25.0)1.7 (0.01, 30.5)0.002 CH50 units8 (3, 27)21 (3, 32.5)20 (3, 32.5)0.033 Prednisone n (%)10 (100)25 (50)35 (58.3)0.003 SELENA-SLEDAI14 (0, 29)8 (0, 18)8 (0,29)0.025 MV, n (%)8 (80)11 (22)19 (31.7)0.001 Hemodyalisis n (%)5 (50)7 (14)12 (20)0.021 Methotrexate, n (%)4 (40)12 (24)16 (26.7)0.433 Azathioprine, n (%)3 (30)13 (26)16 (26.7)1.00 MMF, n (%)6 (60)7 (15)13 (21.7)0.004 Cyclophosphamide, n (%)3 (30)8 (16)11 (18.3)0.371 Rituximab, n (%)2 (20)4 (8)6 (10)0.259 Deceases, n (%)7 (70)9 (18)16 (26.7)0.002 All data are informed as median (minimum,maximum) or otherwise indicated. CRP: C reactive protein, MV: mechanical ventilation, MMF: mycophenolate mofetil. 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 potenti...