Concomitant onset of systemic lupus erythematosus and disseminated histoplasmosis: a case-based review
- PDF / 629,406 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 51 Downloads / 187 Views
Rheumatology International https://doi.org/10.1007/s00296-020-04739-6
INTERNATIONAL
CASE BASED REVIEW
Concomitant onset of systemic lupus erythematosus and disseminated histoplasmosis: a case‑based review Peinado‑Acevedo Juan Sebastián1 · Varela Diana‑Cristina2 · Hidrón Alicia3,4 Received: 3 September 2020 / Accepted: 23 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Concomitant infections during the debut or relapse of systemic lupus erythematosus are a common scenario, due to multiple mechanisms including the use of immunosuppressive drugs and autoimmunity per se. Invasive fungal infections are rare in systemic lupus erythematosus and are associated with profound immunosuppressed states. Disseminated histoplasmosis in patients with lupus has rarely been reported and the concomitant presentation of both entities is exceptional. Methods We describe a case and performed a literature review in order to identify all case reports. A literature search was carried out using in PubMed/MEDLINE, EMBASE and Google Scholar (the first 200 relevant references) bibliographic databases. All available inclusion studies from January 1968 through July 2020. All data were tabulated, and outcomes were cumulatively analyzed. Results Thirty-one additional cases were identified. Disseminated histoplasmosis was the most common clinical presentation and most cases have been reported in patients with a prior diagnosis of lupus in the setting of moderate to high steroid dose use, usually in combination with some other immunosuppressant. Description at systemic lupus disease onset was only reported in 3 cases with a high associated mortality. In our patient, severe disease activity, significant immunosuppression, malnutrition and multi-organ compromise conditioned the patient’s fatal outcome. Conclusion Histoplasmosis can closely mimic activity of lupus. Thus, early clinical recognition is important since a delay in diagnosis and treatment can lead to fatal outcomes. Keywords Histoplasmosis · Systemic lupus erythematosus · Capsulatum · Histoplasma
Introduction Systemic lupus erythematosus (SLE) is a relapsing multisystem autoimmune disease with defects in immunity that predisposes to the development of infections [1]. Invasive fungal infection (IFI) in the SLE setting is unusual: an incidence of less than 1% has been reported, but in an endemic * Varela Diana‑Cristina [email protected] 1
Departament of Internal Medicine, Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Medellín, Colombia
2
Departament of Rheumatology, Universidad Pontificia Bolivariana, Medellín, Colombia
3
Department of Infectious Diseases, Hospital Pablo Tobón Uribe, Medellín, Colombia
4
Department of Medicine, Universidad Pontificia Bolivariana, Medellin, Colombia
country like Colombia, a cross-sectional, retrospective study in patients with SLE reported a 7.5% incidence of IFI [2, 3]. Most cases have been reported in patients with a prior diagnosis of SLE in
Data Loading...
