Section of Rheumatology, Clinical Immunology and Osteoporosis, University of Santo Tomas, Manila, Philippines.
Int J Rheum Dis. 2009 Sep;12(3):234-8. doi: 10.1111/j.1756-185X.2009.01416.x.
Infections including those of the central nervous system (CNS) are a major contributor to morbidity and mortality in systemic lupus erythematosus (SLE). This case series describes the etiology, contributing factors and outcomes of CNS infections in a group of Filipino patients with SLE.
Retrospective case series.
We reviewed the medical records of SLE patients diagnosed and confined for a CNS infection at the University of Santo Tomas Hospital in Manila, Philippines, from 1997 to 2007.
A total of 23 SLE patients (22 females) diagnosed with CNS infection were included in this study. The mean age was 25.8 years (range 12-51) at SLE diagnosis, and 30.9 years (range 14-58) at CNS infection, with a mean disease duration of 55 months (range 7-125). Nineteen cases (82.6%) were meningitis, and four (17.4%) were diagnoses of brain abscess. The etiologic agents were identified as Cryptococcus neoformans in seven (30.4%), Mycobacterium tuberculosis in seven (30.4%), Streptococcus pneumoniae in two (8.7%), Salmonella sp. in one (4.4%), Corynebacterium bovis with Actinomyces sp. in one (4.4%), and no isolate in five (21.7%). The average daily prednisone dose was 28.9 mg (range 0-60 mg); 10 patients had recently received pulse cyclophosphamide, and two were on mycophenolate mofetil at the time of infection. Most cases had active SLE; the lone patient in disease remission had S. pneumoniae meningitis post-splenectomy. The most common presentation was headache (100%) and fever (87%). The infection resolved completely in nine patients (39.1%), and resolved with sequelae in two patients (8.7%); 12 patients (52.2%) died.
We described the etiology and outcomes of CNS infections in a group of Filipino patients with SLE. Risk factors included active SLE in the majority of cases requiring moderate- to high-dose steroids and other immunosuppressants like cyclophosphamide. Although C. neoformans and M. tuberculosis were the most common etiologic agents, it is just as important to search for less common organisms which can produce disease in highly susceptible hosts. A high index of suspicion and early appropriate management are crucial to favorable outcome among these patients.
感染，包括中枢神经系统（CNS）感染，是红斑狼疮（SLE）患者发病率和死亡率的主要原因。本病例系列描述了一组菲律宾 SLE 患者 CNS 感染的病因、相关因素和结局。
回顾性病例系列研究。
我们回顾了 1997 年至 2007 年间在菲律宾马尼拉圣托马斯大学医院诊断和治疗 CNS 感染的 SLE 患者的病历。
本研究共纳入 23 例 SLE 患者（22 例女性），诊断为 CNS 感染。SLE 确诊时的平均年龄为 25.8 岁（范围 12-51），CNS 感染时的平均年龄为 30.9 岁（范围 14-58），平均病程为 55 个月（范围 7-125）。19 例（82.6%）为脑膜炎，4 例（17.4%）为脑脓肿。病原体分别为新型隐球菌 7 例（30.4%）、结核分枝杆菌 7 例（30.4%）、肺炎链球菌 2 例（8.7%）、沙门氏菌 1 例（4.4%）、牛分枝杆菌与放线菌 1 例（4.4%），5 例（21.7%）未分离出病原体。平均日泼尼松剂量为 28.9mg（范围 0-60mg）；10 例患者近期接受过环磷酰胺冲击治疗，2 例在感染时使用霉酚酸酯。大多数患者处于活动期 SLE，唯一处于疾病缓解期的患者在脾切除术后发生肺炎链球菌性脑膜炎。最常见的表现为头痛（100%）和发热（87%）。9 例（39.1%）患者感染完全缓解，2 例（8.7%）患者感染缓解后留有后遗症，12 例（52.2%）患者死亡。
我们描述了一组菲律宾 SLE 患者 CNS 感染的病因和结局。大多数患者存在活动期 SLE，需要中到大剂量类固醇和环磷酰胺等其他免疫抑制剂治疗。新型隐球菌和结核分枝杆菌虽然是最常见的病原体，但在高度易感宿主中，寻找不常见的病原体也同样重要。这些患者需要高度怀疑并早期进行适当的治疗，才能获得良好的预后。
