Hansen K E, St Clair E W
Division of Rheumatology, Allergy and Clinical Immunology, Duke University Medical Center, Durham, NC 27710, USA.
Semin Arthritis Rheum. 1998 Dec;28(3):193-9. doi: 10.1016/s0049-0172(98)80036-x.
To report a patient who developed both central nervous system systemic lupus erythematosus (SLE) and disseminated histoplasmosis and to review the literature regarding histoplasma infection in patients with SLE.
MEDLINE review of the medical literature published in English.
Disseminated histoplasmosis occurs rarely in patients with SLE. The main risk factor is treatment with corticosteroids at doses of 20 mg/d or greater. Fever, dyspnea, pleurisy, and weight loss are typical presenting symptoms. The most commonly involved tissues are lung, liver, and bone marrow. In our patient, both SLE flare and disseminated histoplasmosis were present simultaneously.
Opportunistic infection is an important complication of SLE and may be difficult to diagnose. Symptoms of infection may mimic those of a lupus flare, or conversely, symptoms may be masked by the use of corticosteroids. Fever, unexplained tissue involvement, atypical clinical patterns, and poor response to immunosuppressive therapy should alert the clinician to aggressively pursue evaluation of possible infection in patients with SLE.
报告一名同时发生中枢神经系统系统性红斑狼疮（SLE）和播散性组织胞浆菌病的患者，并复习有关SLE患者组织胞浆菌感染的文献。
对以英文发表的医学文献进行MEDLINE检索。
播散性组织胞浆菌病在SLE患者中很少见。主要危险因素是使用剂量为20mg/d或更高的皮质类固醇治疗。发热、呼吸困难、胸膜炎和体重减轻是典型的表现症状。最常受累的组织是肺、肝和骨髓。在我们的患者中，SLE病情活动和播散性组织胞浆菌病同时存在。
机会性感染是SLE的重要并发症，可能难以诊断。感染症状可能与狼疮病情活动的症状相似，或者相反，症状可能被皮质类固醇的使用所掩盖。发热、不明原因的组织受累、非典型临床模式以及对免疫抑制治疗反应不佳，应提醒临床医生积极评估SLE患者可能的感染情况。
