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Cytomegalovirus (CMV) infection and disease is a condition usually described in immunocompromised patients, but among them, those with connective tissue diseases are poorly represented. Here we present the clinical, laboratory characteristics, management and outcomes of systemic lupus erythematosus (SLE) patients who presented with a CMV infection/disease to a high complexity hospital in southwestern Colombia between 2011 and 2020. 16 SLE patients were found to have a CMV infection. SLE was predominantly characterized by renal involvement (10 patients; 62.50%), and 14 patients (87.5%) were receiving steroids previous to the CMV infection. The entire sample required hospital admission, mainly related to acute kidney injury, and nine patients were admitted to the intensive care unit (ICU). Gastrointestinal organ damage was the most common CMV disease manifestation. All patients received ganciclovir, five of them (31.25%) suffered from septic shock, and seven (43.75%) died. Age ≥38 years and the presence of septic shock at admission were correlated to the mortality outcome. To our knowledge, this is the first publication evaluating SLE patients with CMV infection/disease in a Colombian population.
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Infecções por Citomegalovirus , Lúpus Eritematoso Sistêmico , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/epidemiologia , Colômbia/epidemiologia , Feminino , Adulto , Masculino , Pessoa de Meia-Idade , Antivirais/uso terapêutico , Adulto Jovem , Ganciclovir/uso terapêutico , Hospedeiro Imunocomprometido , Choque Séptico/etiologia , Estudos Retrospectivos , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/epidemiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricosRESUMO
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with various clinical manifestations, including, rarely, a form of interstitial cystitis (lupus cystitis, LC). LC can be asymptomatic and usually has discrete symptoms that improve with conventional therapies available for SLE and/or typical interstitial cystitis. A very severe and refractory form is rarely described. In this study, we present four patients with SLE and a very severe form of noninfectious cystitis refractory to the different forms of treatment described. The clinical descriptions of the cases, demographic factors, manifestations associated with SLE, and clinical and paraclinical manifestations related to cystitis, treatments, and outcomes are provided. A proposal for the pathogenesis of this condition is based on the common findings of these patients, including the fact that three were in SLE remission and all four receiving rituximab as induction and/or maintenance therapy.
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The presentation of data on the Table 3 of the published version of the above mentioned article was incorrect. The heading "Bacterial infections" should be presented under the heading "Infections". The original article has been corrected.
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INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with high mortality rates. This study aimed to describe the main causes of death in a case series of SLE patients attended in a single center in Colombia. METHODS: We conducted a retrospective review and analysis of records of SLE patients who died between January 2011 and June 2017. We extracted the main causes of death and described variables associated with this outcome as well as variables associated with the disease and its treatment. RESULTS: From a total of 1776 patients with SLE, we identified 49 fatal cases (89.8% women, n = 44). The average age at death was 40.6 years (SD 17.4), and patients had a median of 4.5 years (IQR 2-8) of disease duration. The main findings included lymphopenia in 44 patients (89.9%), biopsy-confirmed lupus nephritis (LN)-types IV and VI-in 38 (77.6%), catastrophic antiphospholipid syndrome (CAPS) in 8 (16.3%), and persistent hypocomplementemia (C3 and C4) in 8 (16.3%). The median SLE disease activity index (SLEDAI-2K) score at the time of death was 19 (IQR 11-39). The main cause of death was SLE activity and lupus-induced damage in 22 (44.9%) patients. CONCLUSION: The main causes of death included SLE activity refractory to immunosuppressive treatment, and nosocomial bacterial infections. The patients who died had persistently high SLEDAI scores, types IV and VI LN, associated antiphospholipid syndrome, and persistent hypocomplementemia, requiring severe immunosuppression and prolonged hospitalization.
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Lúpus Eritematoso Sistêmico/mortalidade , Adolescente , Adulto , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/mortalidade , Colômbia/epidemiologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Infecções/complicações , Infecções/mortalidade , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Nefrite Lúpica/complicações , Nefrite Lúpica/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Trombocitopenia/complicações , Trombocitopenia/mortalidade , Adulto JovemRESUMO
INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by organ damage, flare-remission pattern, and increased mortality when compared with the general population. SLE mortality depends on epidemiological, sociodemographic, genetic, and clinical factors. Mortality causes have been mainly grouped in disease activity, infections, and cardiovascular complications. Lupus nephritis and neuropsychiatric lupus are the main manifestations associated to mortality. Bacterial infection remains an important cause of death, and cardiovascular mortality is almost double when compared to age - and sex-matched comparisons. Characteristics such as time from onset to diagnosis > 1-year, renal involvement, high SLEDAI and severe organ involvement, may be predictors of mortality. Interventions including steroids, immunosuppressants, plasmapheresis, some biologics, and vaccination have shown efficacy in reducing mortality rates. Areas covered: In this narrative review the epidemiology, main causes of mortality, potential predictors, and interventions are described. Expert commentary: Despite early diagnosis and immunosuppressive treatment, SLE mortality remains high. African-American, Hispanic-American origin, low socioeconomic status and male sex are associated with increased mortality. Currently, there is no unique, precise prediction model for mortality; however, predictors for increased activity such as infections and cardiovascular events, lead to increased mortality. New prediction models may indicate early interventions in order to improve mortality rates.