Gonzalez-Crespo M R, Gomez-Reino J J
Rheumatology Unit, Hospital Doce de Octubre, Madrid, Spain.
Semin Arthritis Rheum. 1995 Apr;24(5):304-14. doi: 10.1016/s0049-0172(95)80002-6.
Invasive aspergillosis is seldomly described in systemic lupus erythematosus. We present two cases of aspergillosis and review 21 cases reported between 1957 and 1994. The typical clinical presentation is fever and cough in a hospitalized SLE patient previously treated with corticosteroids, immunosuppressors, and broad-spectrum antibiotics. Unlike aspergillosis in other conditions, granulocytopenia is uncommon. Chest radiographs show diffuse or patchy infiltration of lung fields. Diagnosis was suspected premortem in 2 patients. Aspergillus fumigatus was identified or isolated in sputum or parenchimal tissues in the majority of cases. Twenty-two patients died (95%). The finding of hyphae in the sputum of a systemic lupus erythematosus patient with a suggestive clinical picture should lead to bronchoscopy, bronchoalveolar lavage, and lung biopsy. Proof of diagnosis will come from the demonstration of hyphae in tissues and isolation of aspergillus from tissue cultures. Long-term therapy with amphotericin B alone or in combination with fluorocytosine or itraconazole may help improve survival.
侵袭性曲霉病在系统性红斑狼疮中鲜有报道。我们报告了2例曲霉病病例，并回顾了1957年至1994年间报道的21例病例。典型的临床表现为住院的系统性红斑狼疮患者在先前接受皮质类固醇、免疫抑制剂和广谱抗生素治疗后出现发热和咳嗽。与其他情况下的曲霉病不同，粒细胞减少并不常见。胸部X线片显示肺野弥漫性或斑片状浸润。2例患者生前被怀疑患有该病。大多数病例中，在痰液或实质组织中鉴定或分离出烟曲霉。22例患者死亡（95%）。对于具有提示性临床表现的系统性红斑狼疮患者，若痰液中发现菌丝，应进行支气管镜检查、支气管肺泡灌洗和肺活检。诊断的确立将来自组织中菌丝的证明以及从组织培养中分离出曲霉。单独使用两性霉素B或与氟胞嘧啶或伊曲康唑联合进行长期治疗可能有助于提高生存率。
