感染症與全身性紅斑狼瘡

Infections: inseparable from lupus?

Infections are common in systemic lupus erythematosus (SLE). In this issue, Pan et al. report on the investigation of the causes and risk factors for 209 SLE patients presenting to the emergency room. Leading the way are infection (42.6% of patients), disease activity (24.4%), and concomitant activity and infection (3.8%). Primary or subsequent nosocomial infections are the most common causes of death, and associated risk factors include higher disease activity, damage index, elevated clinical doses of steroids, or a recent hospitalization. Hsu et al. subsequently report an extensive soft tissue Burkholderia pseudomallei infection, i.e. melioidosis, in a 14 year-old lupus patient, who was fortunate to completely recover by early aggressive investigation and antibiotic treatment. Earlier on, Chen et al. at Rheumatology (Oxford) [1] has elucidated that SLE patients who experience an invasive fungal infection that proves to be fatal are most typically affected by Cryptococcus neoformans. Higher disease activity and concomitant administration of elevated steroid dosages are linked to the fatalities. Moreover, Chen et al. at J Rheumatol [2], Yu et al. at Med Microbiol Immunol [3] and Lu et al. at Lupus [4] simultaneously demonstrate that lupus patients have abnormally high frequencies of Epstein-Barr virus (EBV) infection compared with healthy controls. Lupus patients are apparently at high-risk for various infections.