1690. Risk Factors of Invasive Aspergillosis in Systemic Lupus Erythematosus Patients

Abstract Background Invasive aspergillosis (IA) has been reported in systemic lupus erythematosus (SLE) patients. We assessed the risk factors of invasive aspergillosis in SLE patients. Methods A retrospective age- and sex-matched case–control study with ratio 3:1 in adult SLE patients from January 2002- December 2017 at Srinagarind Hospital, Khon Kaen University, KhonKaen, Thailand has been conducted. We excluded the patients who were overlap with other immunocompromised condition. Results Of 1,585 SLE patients, 22 patients (1.4%) had invasive aspergillosis and 66 controls were included in the study. The mean age was 36.9 ± 11.8 years and 76 (86.4%) patients were female. SLE patients who developed IA had statistically significant lower median total absolute lymphocyte count than control (503 vs. 1342 cells/mm3, P = 0.05) and history of steroid treatment (adjusted OR 21.43, P = 0.006) were the risk factor of IA. Conclusion There was a low prevalence of IA in SLE patients. Low total lymphocyte count, renal impairment and history of steroid treatment were significantly associated with invasive aspergillosis in SLE patients. Disclosures All authors: No reported disclosures.

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AB0507 INVASIVE ASPERGILLOSIS IN ADULT RHEUMATOLOGICAL PATIENTS IN SAINT PETERSBURG, RUSSIA.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3796 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1551.1-1552

Author(s):

V. Mazurov ◽

O. Shadrivova ◽

M. Shostak ◽

L. Martynova ◽

M. Tonkoshkur ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Renal Failure ◽

Invasive Aspergillosis ◽

Lupus Erythematosus ◽

Granulomatosis With Polyangiitis ◽

Control Group ◽

Systemic Lupus ◽

Anca Associated Vasculitis ◽

Underlying Diseases

Background:Invasive aspergillosis (IA) is a severe opportunistic infection that is not well understood in rheumatological patients.Objectives:To study risk factors, etiology, clinical manifestations and results of treatment of IA in adult rheumatological patients.Methods:Retrospective analysis of 830 patients (1998-2019) with “proven” and “probable” IA (EORTC / MSG, 2019), adults - 699 (84%). The main group included 18 (3%) adult rheumatological patients with IA, a control group included 610 (87%) adult hematological patients. Rheumatological patients were older, the average age was 59 years (21–75) vs 45 years (18–79), p = 0.005, and among them there were more women – 56% vs 42%, p = 0.01.Results:In rheumatological patients with IA, underlying diseases were ANCA-associated vasculitis (28%), granulomatosis with polyangiitis (22%), periarteritis (11%), systemic lupus erythematosus (22%), rheumatic heart disease (11%) and ankylosing spondylitis (6%). In the control group, underlying diseases were acute leukemia (45%), lymphomas (34%), chronic leukemia (9%), multiple myeloma (7%), myelodysplastic syndrome (3%), and other hematological diseases (2%).The main risk factors for IA development in rheumatological patients were: systemic steroids use (89% vs 69%), prolonged lymphocytopenia (76% vs 65%, median - 14 vs 12 days), treatment in ICU (44% vs 18%, p = 0.01), acute or chronic renal failure (39% vs 1%, p = 0.0008) and immunosuppressive therapy (28% vs 25%). Severe neutropenia was noted significantly less frequently (18% vs 83%, p = 0.0001). Additional risk factors were decompensated diabetes mellitus (17% vs 2%, p = 0.004), previous surgery (17% vs 1%, p = 0.001) and organ transplantation (6% vs 0%). In rheumatological patients, lung (83% vs 98%, p = 0.0001) and ≥2 organs (6% vs 8%) involvement were less common. Heart (11% vs 0%), sinuses (6% vs 5%) and central nervous system (6% vs 4%) involvement more often developed. In rheumatological patients, respiratory failure (61 vs 37%, p = 0.03), hemoptysis (28% vs 7%, p = 0.0001) and chest pain (17% vs 7%, p = 0, 04) were noted more often, less often - fever ≥380С (67% vs 85%, p = 0.01) and cough (61% vs 70%). CT signs of lung damage were similar in both groups, but rheumatologic patients were more likely to show an «air crescent» sign and / or destruction cavity (44% vs 10%, p = 0.0001). In rheumatologic patients, IA was more often confirmed by isolation ofAspergillusspp. from BAL (80% vs 45%, p = 0.005) and by histological examination (22% vs 7%, p = 0.01). The main pathogens wereA. fumigatus(50% vs 43%),A. niger(29% vs 32%), andA. flavus(14% vs 17%).Rheumatological patients were less likely to receive antifungal therapy 89% vs 99%, p = 0,0003. The main drug in both groups was voriconazole. The overall 12-week survival did not significantly differ between groups, but was lower in rheumatological patients with IA (69% vs 81%).Conclusion:In rheumatological patients, invasive aspergillosis more often developed at an older age, mainly in women. The main background diseases were ANCA-associated vasculitis, granulomatosis with polyangiitis, and systemic lupus erythematosus. Typical risk factors were steroids and immunosuppressants use, prolonged lymphocytopenia, ICU stay, and renal failure. The main causative agents wereA. fumigatus,A. niger, andA. flavus. The main localization of infection were lungs. Respiratory failure, hemoptysis and heart involvement were typical. The overall 12-week survival of rheumatological patients with invasive aspergillosis was 69%.Disclosure of Interests:None declared

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Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.120197 ◽

2012 ◽

Vol 39 (12) ◽

pp. 2286-2293 ◽

Cited By ~ 14

Author(s):

ADNAN N. KIANI ◽

JENS VOGEL-CLAUSSEN ◽

ARMIN ARBAB-ZADEH ◽

LAURENCE S. MAGDER ◽

JOAO LIMA ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Lupus Erythematosus ◽

Univariate Analysis ◽

Coronary Plaque ◽

Systemic Lupus ◽

History Of ◽

Noncalcified Plaque

Objective.A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE.Methods.Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.Results.The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant.Conclusion.Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.

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AB0517 Invasive aspergillosis in patients with systemic lupus erythematosus: a retrospective study focus on clinical characteristics and risk factors of in-hospital mortality

10.1136/annrheumdis-2018-eular.1080 ◽

2018 ◽

Author(s):

H. Mingli ◽

C.-Y. Tsai

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Retrospective Study ◽

Hospital Mortality ◽

Invasive Aspergillosis ◽

Lupus Erythematosus ◽

Clinical Characteristics ◽

Systemic Lupus

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Risk and protective factors for thrombosis in systemic lupus erythematosus: results from a large, multi-ethnic cohort

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.093013 ◽

2008 ◽

Vol 68 (2) ◽

pp. 238-241 ◽

Cited By ~ 148

Author(s):

R Kaiser ◽

C M Cleveland ◽

L A Criswell

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Asian Americans ◽

Lupus Erythematosus ◽

Disease Duration ◽

Medication Use ◽

Small Sample ◽

Antiphospholipid Antibody ◽

Systemic Lupus ◽

History Of

Objectives:Few studies have examined thrombosis in systemic lupus erythematosus (SLE), none have included Asian-Americans, and most have had small sample sizes. We analysed risk factors for thrombosis in a large, multi-ethnic SLE cohort.Methods:We studied 1930 SLE subjects, including Caucasians, African-Americans, Asian-Americans and Hispanics. Data were derived from questionnaires and medical records. Documented history of thrombosis was the primary outcome. Explanatory variables included age at SLE diagnosis, gender, ethnicity, disease duration, smoking, antiphospholipid antibody (aPL) status, nephritis and specific medications.Results:Smoking (OR 1.26, p = 0.011), longer disease duration (OR 1.26 per 5 years p = 0.027×10−7), nephritis (OR 1.35, p = 0.036), aPL positivity (OR 3.22, p<10−9) and immunomodulating medication use (OR 1.40, p = 0.011) were statistically significant risk factors for thrombosis. Younger age at SLE onset was protective (OR 0.52 for age ⩽20, p = 0.001). After adjusting for disease severity and incorporating propensity scores, hydroxychloroquine use remained significantly protective for thrombosis (OR 0.62, p = 4.91×10−4).Conclusions:This study confirms that older age at onset, longer disease duration, smoking, aPL positivity, history of nephritis and immunomodulating medication use are risk factors for thrombosis in SLE. These data are the first to confirm in a large and ethnically diverse SLE cohort that hydroxychloroquine use is protective for thrombosis.

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Predictors of Incident Seizure in Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.150135 ◽

2016 ◽

Vol 43 (3) ◽

pp. 565-575 ◽

Cited By ~ 12

Author(s):

XiangYang Huang ◽

Laurence S. Magder ◽

Michelle Petri

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Multivariable Analysis ◽

Clinical Manifestations ◽

Systemic Lupus ◽

Malar Rash ◽

History Of

Objective.The risk factors for incident seizures in systemic lupus erythematosus (SLE) were prospectively determined in a cohort study.Methods.A total of 2203 patients with SLE followed longitudinally in the Hopkins Lupus Cohort were analyzed. Demographic variables, clinical manifestations, laboratory tests, and SLE disease activity were recorded at each quarterly visit. Adjusted estimates of association of risk factors for onset of seizure were derived using pooled logistic regression. We examined incident seizures in 3 ways: at the time of diagnosis, more than 45 days after the diagnosis of SLE, and after cohort entry.Results.Of 2203 patients with no history of seizure prior to SLE diagnosis, 157 (7.13%) had the first seizure occurrence at the time of (37 patients, 1.68%) or after diagnosis (120 patients, 5.45%) of SLE. The risk of seizure occurring around the time of SLE diagnosis was higher in patients with a history of malar rash (p = 0.002), proteinuria (p = 0.004), and psychosis (p < 0.001). Multivariable analysis of the first seizure occurring after the diagnosis of SLE showed that history of low C3 (p = 0.0078), psychosis (p < 0.0001), cranial or peripheral neuropathy (p = 0.0043), anti-Sm antibody (p = 0.0551), renal involvement (p = 0.0177), and current corticosteroid dose (p < 0.0001) were independently associated with a higher incidence of seizure. Disease activity was not predictive after adjusting for corticosteroids.Conclusion.Risk of seizure after diagnosis of SLE is increased in those patients with prior psychosis, neuropathy, proteinuria, anti-Sm, low C3, and use of corticosteroids.

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POS0723 HERPES ZOSTER IN A MULTI-ETHNIC SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) COHORT: CLINICAL FEATURES AND RISK FACTORS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1216 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 611.2-612

Author(s):

S. S. Shaharir ◽

S. Rajalingham ◽

R. Mohd ◽

N. Kori ◽

A. Jamil

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Mycophenolate Mofetil ◽

Herpes Zoster ◽

Lupus Erythematosus ◽

Lower Risk ◽

The Other ◽

Systemic Lupus ◽

History Of ◽

Time Of Infection

Background:Systemic Lupus Erythematosus (SLE) patients are at risk of Herpes Zoster (HZ) infection due to the underlying immunosuppressed state. The reported incidence of HZ in SLE is 6 to 10-times higher than the general population.Objectives:To determine the clinical characteristics of SLE patients who develop Herpes Zoster (HZ) infection and their associated risk factors.Methods:Medical records review was performed on consecutive SLE patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from 2018 until 2019. Previous history of HZ and their demographic characteristics, clinical and medications used at the time of infection were recorded. Univariate and multivariate analyses were performed to compare the clinical and treatment characteristics between SLE patients with history of HZ and patients who had never had experienced HZ.Results:A total of 229 patients with predominantly Malay patients (n=123, 53.7%), followed by Chinese (n=90, 39.3%) and others (n=16, 7.0%) were included. A total of 37 patients had history of HZ (16.2%). Their mean age during HZ episode was 34.4 ± 13.8 years and their SLE disease duration was 68.7 ±57.1 months. More than half of them (n=21, 56.8%) developed HZ when the SLE disease was active with the mean dose of prednisolone at the time of infection was 20.7 ± 9.2 mg daily. A total of 21 HZ patients (56.8%) had ever received cyclophosphamide with the median interval of the last infusion was 6 (0.2-84) months. Almost half of the HZ patients (n=18, 48.6%) developed the infection while on cyclosporine A. Meanwhile, 4 (10.8%) were on azathioprine and mycophenolate mofetil respectively. Chinese patients tend to have HZ as compared to other ethnics (27% vs 41.7%), p=0.07. HZ occurred in a higher proportion among male patients (29%) as compared to female patients (14.1%), p=0.05. The use of azathioprine (10.8% vs 55.2%, p<0.01) and mycophenolate mofetil (10.8% vs 31.8%, p=0.009) were less associated with HZ. On the other hand, the use of cyclosporine A (48.6% vs 32.3%, p=0.05) and prednisolone ≥ 60mg daily (44.4% vs 28%, p=0.04) were associated with HZ. Higher HZ patients had hematological manifestation (81.1% vs 62.5%, p=0.04) and positive lupus anticoagulant (LA), 32.4% vs 14.6%, p=0.02. A forward logistic regression which included all factors with p<0.1 in the univariate analyses revealed that the use of prednisolone ≥ 60mg daily and hematological manifestation were the independent predictors of HZ with OR= 2.28 (95% C.I = 1.01-5.17), p=0.049 and OR= 2.78 (95% C.I = 1.09-7.04), p=0.03 respectively. The use of azathioprine was associated with a lower risk of HZ with OR 0.08 (95% C. I= 0.03-0.25), p=<0.01.Conclusion:Our study demonstrated the possible influence of male gender, Chinese ethnicity and disease characteristics such as hematological manifestation and lupus anticoagulant positivity with the occurrence of HZ. In addition, the use high dose oral prednisolone ≥ 60mg daily was the independent predictor of HZ while on the other hand, the use of azathioprine was associated with a lower risk of developing HZ as compared to other immunosuppressive agents. Further larger studies are needed to confirm these associations.References:[1]Chen D, Li H, Xie J, Zhan Z, Liang L, Yang X. Herpes zoster in patients with systemic lupus erythematosus: Clinical features, complications and risk factors. Exp Ther Med. 2017;14(6):6222-6228.Disclosure of Interests:None declared

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Invasive Aspergillosis Masquerading as Catastrophic Antiphospholipid Syndrome

American Journal of Critical Care ◽

10.4037/ajcc2013659 ◽

2013 ◽

Vol 22 (5) ◽

pp. 448-451 ◽

Cited By ~ 7

Author(s):

Kathryn S. Robinett ◽

Bethany Weiler ◽

Avelino C. Verceles

Keyword(s):

Systemic Lupus Erythematosus ◽

Invasive Aspergillosis ◽

Antiphospholipid Syndrome ◽

Lupus Erythematosus ◽

Signs And Symptoms ◽

Subdural Hemorrhage ◽

Systemic Lupus ◽

Catastrophic Antiphospholipid Syndrome ◽

Oral Ulcers ◽

History Of

A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. She was treated with an intravenous infusion of heparin, but she experienced a subdural hemorrhage and died on day 10 of the hospitalization. An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the differential diagnosis for any patient who is immunosuppressed, including patients with autoimmune diseases such as systemic lupus erythematosus.

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Invasive aspergillosis in patients with systemic lupus erythematosus: a retrospective study on clinical characteristics and risk factors for mortality

Lupus ◽

10.1177/0961203318796294 ◽

2018 ◽

Vol 27 (12) ◽

pp. 1944-1952 ◽

Cited By ~ 3

Author(s):

ML Hung ◽

HT Liao ◽

WS Chen ◽

MH Chen ◽

CC Lai ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Invasive Aspergillosis ◽

Steroid Therapy ◽

Mortality Risk ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Pulse Steroid Therapy ◽

Concurrent Infections ◽

Pulse Steroid

Objective The objective of this paper is to analyze the clinical features, outcomes, mortality risk factors, and all-cause mortalities of invasive aspergillosis (IA) in patients with systemic lupus erythematosus (SLE). Methods Medical records were reviewed to identify SLE patients with IA from January 2006 to June 2017, at Taipei Veterans General Hospital, Taiwan. A total of 6714 SLE patients were included. Clinical/laboratory parameters and treatment outcomes were analyzed. Results Four patients (19.0%) had definite and 17 had probable (81.0%) IA. Seven patients (33.3%) survived and 14 died (66.7%). Concurrently, there were 19 pneumonias (90.5%), 17 cases of other infections (81.0%), eight bacteremia (38.1%), nine cytomegalovirus (CMV, 42.7%) and six Candida (28.6%) infections. In all 55 blood cultures, 38 (69.1%) yielded gram-negative bacilli, of which carbapenem-resistant A. baumannii accounted for eight (21.1%); 17 (30.9%) yielded gram-positive cocci, of which methicillin-resistant S. aureus accounted for six (35.3%); and vancomycin-resistant Enterococcus accounted for four (23.5%). Daily steroid dose ≥ 20 mg (hazard ratio (HR) 2.00), recent pulse steroid therapy (HR 2.80), azathioprine (HR 2.00), rituximab (HR 2.00), plasmapheresis (HR 2.00), acute respiratory distress syndrome (HR 2.00), concurrent infections (HR 5.667) and CMV viremia (HR 1.75) were higher in the fatality group. All p values were less than 0.05. Septic shock ( n = 7, 50% in the fatality group) is the most common cause of mortality. Conclusions High daily steroid dosing, recent pulse steroid therapy, azathioprine, rituximab, concurrent infections, and CMV viremia were mortality risk factors for IA in SLE.

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