Secondary immunodeficiency with infectious complications following immunosuppressive therapy in a female patient with systemic lupus erythematosus
Authors:
L. Podrazilová 1; J. Vencovský 1; O. Kryštůfková 1; M. Podrazil 2; C. Dostál 1; K. Pavelka 1
Authors place of work:
Revmatologický ústav, Praha, 2Ústav imunologie, 2. LF UK, Praha
1
Published in the journal:
Čes. Revmatol., 17, 2009, No. 2, p. 91-95.
Category:
Case Report
Summary
We present a young female with systemic lupus erythematosus with cutaneous vasculitis, necrotic defects and suspected vasculitis of colon. The glucocorticoid therapy and the administration of pulse intravenous cyclophosphamide led to a decrease in IgG and IgA levels with numerous infectious complications, e.g. Salmonella gonitis, thrush, vaginal mycosis with labial phlegmon and herpetic efflorescence in gluteal area, cultured Staphylococcus aureus from the vasculitic defect on an elbow. The administration of a substitution dose of intravenous immunoglobulins (IVIG), targeted antibiotic, virostatic and antimycotic therapy led to improvement in clinical and laboratory findings. A new onset of diabetes mellitus, presumably induced by glucocorticoids, has been documented.
Key words:
systemic lupus erythematosus, immunodeficiency
Zdroje
1. Cervera R, Khamashta MA, Font J et al and the European Working Party on Systemic Lupus Erythematosus. Morbidity and mortality in systemic lupus erythematosus during a 5-year period: a multicenter prospective study of 1,000 patients. Medicine 1999; 78: 167–75.
2. Fessler BJ. Infectious diseases in systemic lupus erythematosus: risk factors, management and prophylaxis. Best Pract Res Clin Rheumatol 2002; 16(2): 281–91.
3. Sommer S, Piyadigmage A, Goodfield MJ. Systemic lupus erythematosus or infection with HIV, or both? Clin Exp Dermatol 2004; 29(4): 393–5.
4. Zonana- Nacach A, Camargo-Coronel A, Yanez P, et al. Infections in outpatients with systemic lupus erythematosus: a prospective study. Lupus 2001; 10: 505–10.
5. Petri M. Infection in systemic lupus erythematosus. Rheumatic Disease Clinics of North America 1998; 24: 423–56.
6. Zandman-Goddard G, Shoenfeld Y. SLE and infections. Clin Rev Allergy Immunol 2003; d25(1): 29–40.
7. Cupps TR, Edgar LC, Fauci AS. Suppression of human B lymphocyte function by cyclophosphamide. J Immunol 1982; 128: 2453–7.
8. Clements PJ, Davis J Cytotoxic drugs: their clinical application to the rheumatic diseases. Semin Arthritis Rheum 1986; 15: 231–54.
9. Kahl LE. Herpes zoster infections in systemic lupus erythematosus: risk factors and outcome. Journal of Rheumatology 1994; 21: 84–6.
10. Sakamoto O, Ando M, Yishimatsu S, et al. Systemic lupus erythematosus complicated by cytomegalovirus-induced hemophagocytic syndrome and colitis. Intern Med 2002; 41(2): 77–8.
11. Dostál C. Cyklofosfamid. Ve: Farmakoterapii revmatických onemocnění (ed. Pavelka K), Grada, Praha 2005: 105–11.
12. Ward MM, Donald F. Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality. Arthritis and Rheumatism 1999; 42: 780–9.
13. Butler WT, Rossen RD. Effects of corticosteroids on immunity in man. J Clin Invest 1973; 52: 2629–40.
14. Lories RJU, Maertens JA, Ceuppens JL, et al. The use of polyclonal intravenous immunoglobulins in the prevention and treatment of infectious diseases. Acta Clinica Belgica 2000; 55–3: 163–9.
15. ASHP Commission on Therapeutics. ASHP therapeutic guidelines for intravenous immunoglobulin. Clin Pharm 1992; 11: 117–36.
16. Gebauer CM, Borte M, Schille R, et al. Gonarthritis due to Salmonella enteritidis in a patient with systemic lupus erythematosus. Klin Padiatr 2002; 214(5): 319–23.
17. Becker A, van Agtmael MA, Comans EF, et al. Persistent fever in a patient with Salmonella typhimurium gonarthritis. Ned Tijdschr Geneeskd 2005; 149(1): 33–6.
18. Joshua F, Riordan J, Sturgess A. Salmonella typhimurium mediastinal abscess in a patient with systemic lupus erythematosus. Lupus 2003; 12(9): 710–3.
19. Chiu YL, Huang JW, Hsueh PR, et al. CAPD-related peritonitis due to Salmonella enteritidis in a patient with SLE. Am J Kidney Dis 2005; 46(2): 21–3.
20. Tsao CH, Chen CY, Ou LS et al. Risk factors of mortality for salmonella infection in systemic lupus erythematosus. J Rheumatol 2002; 29(6): 1214–8.
21. Lim E, Koh WH, Loh SF. Non-thyphoidal salmonellosis in patients with systemic lupus erythematosus. A study of fifty patients and a review of the literature. Lupus 2001; 10(2): 87–92.
22. Chen JY, Luo SF, Wu YJ. Salmonella septic arthritis in systemic lupus erythematosus and other systemic diseases. Clin Rheumatol 1998; 17(4): 282–7.
23. Manzi S, Kuller LK, Kutzer J, et al. Herpes zoster in systemic lupus erythematosus. Journal of Rheumatology 1995; 22: 1254–8.
24. Chowdhry IA, Tan IJ, Mian A, et al. Systemic lupus erythematosus presenting with features suggestive of human immunodeficiency virus infection. J Rheumatol 2005; 32(7): 1365–8.
25. Saravana S, James DW, Abourawi F, et al. HIV infection mimicking SLE. Clin Rheumatol 2004; 23(6): 562–3.
26. Song J, Park Y.-B, Suh C.-H, et al. Transient panhypogammaglobulinaemia and B lymphocyte deficiency in a patient with neuropsychiatric systemic lupus erythematosus after immunosuppresive therapy. Clin Rheumatol 2003; (22): 62–6.
27. Tsokos GC, Smith PL, Balow JE. Development of hypogammaglobulinaemia in a patient with systemic lupus erythematosus.AmJ Med 1985; 81:1081–4.
28. Cronin ME, Balow JE, Tsokos GC. Immunoglobulin deficiency in patients with systemic lupus erythematosus. Clin Exp Rheumatol 1989; 7: 359–64.
29. Fort JG, Scovern H, Abruzzo JL. Intravenous cyclophosphamide and methylprednisolone for the traetment of bronchiolitis obliterans and interstitial fibrosis associated with cryotherapy. J Rheumatol 1988; 15: 850–4.
30. Tamura A, Agematsu K, Urasawa R et al. Cardiac tamponade due to systemic lupus erythematosus in a 7-year-old boy with selective IgG subclass deficiency. Eur J Pediatr 1998; 157(6): 475–8.
31. Duzgun A, Duman M, Sonel B, et al. Lupus vulgaris in a patient with systemic lupus erythematosus and persistent IgG deficiency. Rheumatol Int 1997; 16(5): 213–6.
32. Dzgun A, Peksari Y, Sonel B, et al. Localization of extrapulmonary tuberculosis in the synovial membrane, skin, and meninges in a patient with systemic lupus erythematosus and IgG deficiency. Rheumatol Int 2002; 22: 41–44.
33. Liblau RS, Bach J-F. Selective IgA deficiency and autoimmunity. Int Arch Allergy Immunol 1992; 99: 16–27.
34. Rifle G. Selective IgA deficiency nad systemic lupus erythematosus. Ann Med Interne (Paris) 1988; 139: 134–7.
35. Rankin ECC, Isenberg DA. IgA deficiency and SLE: prevalence in a clinic population and review of the literature. Lupus 1997; 6: 390–4.
36. Takeuchi T, Nakagawa T, Maeda Y, et al. Functional defects of B lymphocytes in a patient with selective IgM deficiency associated with systemic lupus erythematosus. Autoimmunity 2001; 34(2): 115–22.
37. Tanaka A, Kasahara M, Miyawaki T, et al. A case of selective IgM deficiency associated with systemic lupus erythematosus. Nippon Jinzo Gakkai Shi 1996; 38(4): 185–90.
38. Lories RJU, Maertens JA, Ceuppens JL, Peetermans.WE. The use of polyclonal intravenous immunoglobulins in the prevention and treatment of infectious diseases. Acta Clinica Belgica 2000; 55–3: 163–169.
39. Bayry J, Misra N, Latry V, et al. Mechanism of action of intravenous immunoglobulins in autoimmune and inflammatory diseases. Transfusion Clinique et Biologique 2003; 165–169.
40. ASHP Commission on Therapeutics. ASHP therapeutic guidelines for intravenous immuneglobulin. Clin. Pharm 1992; 11: 117–36.
41. Keller T, McGrath K, Newland A, Gatenby P, et al. Indications for use of intravenous immunoglobulin. The medical journal of Australia 1993; 204–206.
42. Lee ML, Strand V. Intravenous immunoglobulins in clinical practise. New York 1997; 57: 63.
Štítky
Dermatology & STDs Paediatric rheumatology RheumatologyČlánok vyšiel v časopise
Czech Rheumatology
2009 Číslo 2
Najčítanejšie v tomto čísle
- HLA-Cw*0602 is a predisposing allele to develop psoriatic arthritis
- Limited significance of procalcitonin in differentiation between sepsis and flare of a rheumatic disease
- Secondary immunodeficiency with infectious complications following immunosuppressive therapy in a female patient with systemic lupus erythematosus
- Utilization of health care and the costs for patients with rheumatoid arthritis treated with TNF-α inhibitors in the Czech Republic