Sección de Reumatología, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia.
Lupus. 2010 Apr;19(5):639-45. doi: 10.1177/0961203309356458. Epub 2010 Jan 29.
The aims of this study were to describe the clinical features of patients with systemic lupus erythematosus (SLE) who developed cryptococcal infection and ascertain their outcomes when treated with glucocorticoids and immunosuppressive agents in conjunction with long-term maintenance antifungal therapy. Six cases of cryptococcal infection in SLE were reviewed retrospectively. The mean age at the time of infection was 26.3 (11.7) years. Three patients had active SLE and all were receiving glucocorticoids [median prednisone dose of 40 (21.2-60.0) mg/day] at the time of infection diagnosis. Concomitant cytotoxic agents were used in five patients. Meningitis was the most common clinical manifestation (n = 5) and cryptococcemia was found in three cases. The patient, who developed pulmonary cryptococcosis, died from respiratory distress syndrome. All patients received induction anti-fungal therapy with amphotericin B and the five surviving patients switched to oral fluconazole indefinitely as maintenance therapy and none of them has had relapses of cryptococcal infection to last medical evaluation. As SLE patients have intrinsic abnormalities of cell-mediated immunity and receive immunosuppressive therapy, indefinite maintenance therapy with fluconazole is recommended in SLE patients with cryptococcosis.
本研究的目的是描述发生隐球菌感染的系统性红斑狼疮（SLE）患者的临床特征，并确定在接受糖皮质激素和免疫抑制剂联合长期维持抗真菌治疗时的治疗结局。回顾性分析了 6 例 SLE 合并隐球菌感染患者。感染时的平均年龄为 26.3（11.7）岁。3 例患者有活动期 SLE，感染诊断时均正在接受糖皮质激素[泼尼松中位剂量 40（21.2-60.0）mg/天]。5 例患者同时使用细胞毒性药物。最常见的临床表现为脑膜炎（n=5），3 例存在 cryptococcemia。发生肺部隐球菌病的患者死于呼吸窘迫综合征。所有患者均接受两性霉素 B 诱导抗真菌治疗，5 例存活患者转为氟康唑口服治疗作为维持治疗，且在最后一次医学评估时均未复发隐球菌感染。由于 SLE 患者存在细胞介导免疫的固有异常，并接受免疫抑制治疗，因此建议对合并隐球菌感染的 SLE 患者进行氟康唑的无限期维持治疗。
