Brain paracoccidioidomycosis in an immunosuppressed patient with systemic lupus erythematosus

Background: Brain paracoccidioidomycosis (PCM) or neuroparacoccidioidomycosis (NPCM) is a fungal infection of the central nervous system (CNS) caused by Paracoccidioides brasiliensis, a dimorphic fungus. The CNS involvement is through bloodstream dissemination. The association between NPCM and systemic lupus erythematous (SLE) is rare. However, SLE patients are under risk of opportunistic infections given their immunosuppression status. Case Description: The aim of this case report is to present a 37-year-old female with diagnosis of SLE who presented with progressive and persistent headache in the past 4 months accompanied by the right arm weakness with general and neurologic examination unremarkable. The computerized tomography of the head showed left extra-axial parietooccipital focal hypoattenuation with adjacent bone erosion. The brain magnetic resonance imaging reported left parietooccipital subdural collection associated with focal leptomeningeal thickening with restriction to diffusion and peripheral contrast enhancement. The patient underwent a left craniotomy and dura mater biopsy showed noncaseous granulomatosis with multinucleated giant cells with rounded birefringent structures positive for silver stain, consistent with PCM. Management with itraconazole 200 mg daily was started with a total of 12 months of treatment, with patient presenting resolution of headache and right arm weakness. Conclusion: The diagnosis of NPCM is challenging and a high degree of suspicious should be considered in patients with persistent headache and immunosuppression.

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Fatal Disseminated Aspergillosis in a Patient with Systemic Lupus Erythematosus

Case Reports in Infectious Diseases ◽

10.1155/2020/9623198 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Rochelle Hardie ◽

Tracian James-Goulbourne ◽

Monsoon Rashid ◽

Jeremy Sullivan ◽

Yamen Homsi

Keyword(s):

Systemic Lupus Erythematosus ◽

Respiratory Failure ◽

Lupus Erythematosus ◽

Opportunistic Infections ◽

Immunocompromised Patient ◽

Shortness Of Breath ◽

Systemic Lupus ◽

Increased Risk ◽

Life Threatening ◽

Disseminated Aspergillosis

Patients with systemic lupus erythematosus (SLE) are at increased risk for infection including opportunistic infections. Fungal infection in particular can be difficult to diagnose and treat and often can be life-threatening in the immunocompromised patient. We present a case in which a patient with SLE presented to the hospital with shortness of breath and cough. Throughout the hospital course, the patient’s condition continued to decline leading to acute respiratory failure, and eventually, the patient expired. Postmortem autopsy revealed invasive fungal aspergillosis infection involving the heart, lungs, and brain. Earlier diagnosis and treatment with empiric antifungals may improve survival in these patients.

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Dickkopf-1 as Potential Biomarker to Evaluate Bone Erosion in Systemic Lupus Erythematosus

Journal of Clinical Immunology ◽

10.1007/s10875-010-9436-z ◽

2010 ◽

Vol 30 (5) ◽

pp. 669-675 ◽

Cited By ~ 15

Author(s):

Li Long ◽

Yanying Liu ◽

Shiyao Wang ◽

Yi Zhao ◽

Jianping Guo ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Bone Erosion ◽

Systemic Lupus ◽

Potential Biomarker ◽

Dickkopf 1

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Tuberculous sacroiliitis in a patient with systemic lupus erythematosus: a case report and literature review

Lupus ◽

10.1177/0961203318762594 ◽

2018 ◽

Vol 27 (8) ◽

pp. 1378-1382 ◽

Cited By ~ 2

Author(s):

E Calle ◽

L A González ◽

C H Muñoz ◽

D Jaramillo ◽

A Vanegas ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Opportunistic Infections ◽

Left Knee ◽

Systemic Lupus ◽

Osteoarticular Tuberculosis ◽

Antituberculosis Therapy ◽

The Right ◽

Immunological Abnormalities

Systemic lupus erythematosus (SLE) patients are at higher risk of developing opportunistic infections such as tuberculosis (TB), especially extrapulmonary forms like osteoarticular TB, compared to the general population. However, tuberculous sacroiliitis has been scarcely reported in these patients. We present a 34-year-old woman with SLE who developed articular tuberculosis simultaneously affecting the right sacroiliac joint and the left knee. The patient was successfully treated with antituberculosis therapy for nine months. In this case, in addition to the immunological abnormalities of lupus, the long-term glucocorticoid therapy at high dosages was the main risk factor for the development of osteoarticular tuberculosis.

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Systemic lupus erythematosus and infections

Reumatismo ◽

10.4081/reumatismo.2020.1303 ◽

2020 ◽

Vol 72 (3) ◽

pp. 154-169

Author(s):

B.K. Singh ◽

S. Singh

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Opportunistic Infections ◽

Immunosuppressive Agents ◽

Immune Dysregulation ◽

Systemic Lupus ◽

Irreversible Damage ◽

Increased Risk ◽

Increased Susceptibility

Systemic lupus erythematosus (SLE) is an inflammatory and multi-systemic autoimmune disorder, characterized by an uncontrolled auto-reactivity of B and T lymphocytes, leading to the production of autoantibodies against self-directed antigens and tissue damage. The life expectancy in patients with SLE has improved tremendously in the last two decades, but the mortality rates still remain three times greater compared to those of the general population. Despite increased awareness and improved management, infections remain a major source of morbidity, mortality, hospitalization, and death in patients with SLE. The infections in SLE patients widely range from opportunistic to common bacterial and viral infections with typical or atypical presentations. Moreover, SLE patients exhibit an increased susceptibility to hospital-acquired infections. Factors associated with increased risk of infections include high disease activity, specific immune dysregulation, drug-induced immune deficiency, and organ failure with irreversible damage. Furthermore, immunosuppressive agents may make patients more susceptible to opportunistic infections. A big challenge faced by physicians in these patients is to distinguish between infections and flares of SLE, as infections may mimic them, leading to predicament in diagnosis and appropriate management. Immunosuppression used to treat severe flares of lupus can have catastrophic complications in patients with active infections. There is an urgent need for biomarkers to make an accurate differential diagnosis in this situation. In spite of increased understanding of SLE, many questions remain unanswered. Further research is needed to determine specific immune dysregulation underlying the increased susceptibility to specific infections, predictors of infection in SLE such as genetic markers, and biomarkers that discriminate between disease activity and active infections. Also, measures must be evaluated appropriately to prevent infections, and their complications in SLE.

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A Patient with Systemic Lupus Erythematosus Complicated by Neurological Symptoms of Toluene Poisoning

Case Reports in Rheumatology ◽

10.1155/2013/390960 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Kentaro Isoda ◽

Tohru Takeuchi ◽

Shigeki Makino ◽

Toshiaki Hanafusa

Keyword(s):

Systemic Lupus Erythematosus ◽

Cerebrospinal Fluid ◽

Lupus Erythematosus ◽

Brain Magnetic Resonance Imaging ◽

Neurological Symptoms ◽

Emission Computed Tomography ◽

Systemic Lupus ◽

Laboratory Findings ◽

Neuropsychiatric Systemic Lupus Erythematosus ◽

Dsdna Antibody

We report a patient with systemic lupus erythematosus complicated by toluene poisoning. She had erythema, alopecia, arthralgia, and various neurological symptoms. Laboratory findings showed leukocytopenia, low levels of complements, and anti-dsDNA antibody. However, normal interleukin-6 level and IgG index of cerebrospinal fluid and brain magnetic resonance imaging and single photon emission computed tomography findings suggested that her neurological symptoms were caused by metabolic disorder but not neuropsychiatric systemic lupus erythematosus. Erythema, alopecia, and arthralgia improved rapidly after administration of prednisolone and tacrolimus, whereas neurological symptoms improved only gradually. Because of a history of exposure to toluene, her neurological symptoms were considered to be due to toluene poisoning. The differentiation of toluene poisoning from neuropsychiatric systemic lupus erythematosus based on symptoms is difficult because both induce various neuropsychiatric disorders. Laboratory findings of cerebrospinal fluid, radiological findings, and medical interview were useful for differentiation of toluene poisoning from neuropsychiatric systemic lupus erythematosus.

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Bilateral retroperitoneal liposarcoma in immunosuppressed patient with systemic lupus erythematosus

Urology ◽

10.1016/0090-4295(83)90351-5 ◽

1983 ◽

Vol 22 (1) ◽

pp. 64-66 ◽

Cited By ~ 6

Author(s):

Kamran Nikravan ◽

Bassam B. Bejjani ◽

Mitchell Edson

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Immunosuppressed Patient ◽

Systemic Lupus ◽

Retroperitoneal Liposarcoma

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Cytokines and Chemokines in Neuropsychiatric Syndromes of Systemic Lupus Erythematosus

Journal of Biomedicine and Biotechnology ◽

10.1155/2010/268436 ◽

2010 ◽

Vol 2010 ◽

pp. 1-8 ◽

Cited By ~ 40

Author(s):

Hiroshi Okamoto ◽

Akiko Kobayashi ◽

Hisashi Yamanaka

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Neuropsychological Tests ◽

Brain Magnetic Resonance Imaging ◽

Systemic Lupus ◽

Cytokines And Chemokines ◽

Neuropsychiatric Manifestations ◽

Life Threatening ◽

Magnetic Resonance Imaging Mri ◽

Electroencephalogram Eeg

Neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE) is a life-threatening disorder and early diagnosis and proper treatment are critical in the management of this neuropsychiatric manifestations in lupus. Brain magnetic resonance imaging (MRI), electroencephalogram (EEG), neuropsychological tests, and lumbar puncture are clinical used for the diagnosis of NPSLE. In addition to these tests, cytokine and chemokine levels in CSF have been reported as useful diagnostic marker of NPSLE. Based on the number of recently published studies, this review overviewed the roles of cytokines and chemokines in NPSLE.

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