紅斑性狼瘡患者發生中樞神經系統感染核磁共振影像與臨床特徵的回溯性研究

Magnetic resonance imaging and clinical features in lupus patients with central nervous system infection: a retrospective study

Objective: Central nervous system (CNS) infections are life-threatening in patients with systemic lupuserythematosus (SLE). The aim of this study was to determine the magnetic resonance imaging (MRI)findings and the clinical characteristics of SLE patients with CNS infections.Methods: The medical records of 8 consecutive SLE patients with CNS infection admitted to TaipeiVeterans General Hospital (TVGH) from January 2005 to December 2016 were reviewed retrospectively.Results: The clinical features in SLE patients with CNS infections included an increase in C-reactiveprotein (5.8±4.3 mg/dL), the presence of anti-dsDNA antibodies (88%) in serum, and an elevated SLEDisease Activity Index (SLEDAI) score ( > 5, 100%). Fever and headache were the most commonmanifestations (75%). Cranial MRI revealed leptomeningeal enhancement (37.5%), rim-enhanced lesions(12.5%) and intracranial hemorrhage (25%). Cryptococcus species was the most common pathogen (2cases, 25%). After the administration of antibiotics targeting the pathogens, 7 patients (87.5%) recovered.Conclusion: CNS infection is uncommon in SLE patients. Fever, headache, increased serum CRP are theleading presentations, which should drive clinicians to carry out cranial MRI and CSF studies in a timelymanner to identify CNS infections. Different pathogens of CNS infections in lupus patients may sharecommon imaging characteristics, which lead to obscurity in early imaging appearance for differentialdiagnosis. The input of clinical symptoms, laboratory findings and MR imaging patterns are essential forrapidly recognizing and identifying the culprit pathogens and to initiate treatments as early as possible. 目的：紅斑性狼瘡患者罹患中樞神經系統感染會產生致命的危險。這個研究的目的是探討紅斑性狼瘡患者在中樞神經系統感染後核磁共振影像與臨床特徵。方法：針對西元2005年1月至2016年12月之間於臺北榮民總醫院診斷中樞神經系統感染的8位紅斑性狼瘡患者進行回溯性分析。結果：紅斑性狼瘡患者在中樞神經系統感染時，其血清學檢查中可發現，C-反應蛋白上升及抗雙股DNA抗體表現；其SLE疾病活動度量表分數皆大於5分。臨床表現以發燒以及頭痛最多。頭部核磁共振以腦膜顯影增強、邊緣顯影增強的病灶及顱內出血為主。隱球菌是最多的病原菌。接受適當的抗生素治療後，8位病患中共有7位復原。結論：中樞神經系統感染在紅斑性狼瘡患者並不常見，而發燒、頭痛、C-反應蛋白上升是臨床上最常見的特徵。當病人有以上表現時，臨床醫師應實施腦部核磁共振以及腦脊髓液穿刺檢查，儘早確認中樞神經系統感染。對紅斑性狼瘡患者來說，及早確認病原菌以及接受適當的治療是相當重要的。