Juan Sebastián Peinado-Acevedo1, Diana-Cristina Varela2, Alicia Hidrón3,4. 1. Departament of Internal Medicine, Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Medellín, Colombia. 2. Departament of Rheumatology, Universidad Pontificia Bolivariana, Medellín, Colombia. dianacristinavarela@gmail.com. 3. Department of Infectious Diseases, Hospital Pablo Tobón Uribe, Medellín, Colombia. 4. Department of Medicine, Universidad Pontificia Bolivariana, Medellin, Colombia.
Abstract
INTRODUCTION: Concomitant infections during the debut or relapse of systemic lupus erythematosus are a common scenario, due to multiple mechanisms including the use of immunosuppressive drugs and autoimmunity per se. Invasive fungal infections are rare in systemic lupus erythematosus and are associated with profound immunosuppressed states. Disseminated histoplasmosis in patients with lupus has rarely been reported and the concomitant presentation of both entities is exceptional. METHODS: We describe a case and performed a literature review in order to identify all case reports. A literature search was carried out using in PubMed/MEDLINE, EMBASE and Google Scholar (the first 200 relevant references) bibliographic databases. All available inclusion studies from January 1968 through July 2020. All data were tabulated, and outcomes were cumulatively analyzed. RESULTS: Thirty-one additional cases were identified. Disseminated histoplasmosis was the most common clinical presentation and most cases have been reported in patients with a prior diagnosis of lupus in the setting of moderate to high steroid dose use, usually in combination with some other immunosuppressant. Description at systemic lupus disease onset was only reported in 3 cases with a high associated mortality. In our patient, severe disease activity, significant immunosuppression, malnutrition and multi-organ compromise conditioned the patient's fatal outcome. CONCLUSION: Histoplasmosis can closely mimic activity of lupus. Thus, early clinical recognition is important since a delay in diagnosis and treatment can lead to fatal outcomes.
INTRODUCTION: Concomitant infections during the debut or relapse of systemic lupus erythematosus are a common scenario, due to multiple mechanisms including the use of immunosuppressive drugs and autoimmunity per se. Invasive fungal infections are rare in systemic lupus erythematosus and are associated with profound immunosuppressed states. Disseminated histoplasmosis in patients with lupus has rarely been reported and the concomitant presentation of both entities is exceptional. METHODS: We describe a case and performed a literature review in order to identify all case reports. A literature search was carried out using in PubMed/MEDLINE, EMBASE and Google Scholar (the first 200 relevant references) bibliographic databases. All available inclusion studies from January 1968 through July 2020. All data were tabulated, and outcomes were cumulatively analyzed. RESULTS: Thirty-one additional cases were identified. Disseminated histoplasmosis was the most common clinical presentation and most cases have been reported in patients with a prior diagnosis of lupus in the setting of moderate to high steroid dose use, usually in combination with some other immunosuppressant. Description at systemic lupus disease onset was only reported in 3 cases with a high associated mortality. In our patient, severe disease activity, significant immunosuppression, malnutrition and multi-organ compromise conditioned the patient's fatal outcome. CONCLUSION: Histoplasmosis can closely mimic activity of lupus. Thus, early clinical recognition is important since a delay in diagnosis and treatment can lead to fatal outcomes.
Authors: J P Vinicki; S Catalan Pellet; C Pappalardo; V C Cruzat; M A Spinetto; D Dubinsky; I N Tiraboschi; H A Laborde; G Nasswetter Journal: Lupus Date: 2013-07-16 Impact factor: 2.911
Authors: Santiago Bernal-Macías; Benjamín Reyes-Beltrán; Nicolás Molano-González; Daniel Augusto Vega; Claudia Bichernall; Luis Aurelio Díaz; Adriana Rojas-Villarraga; Juan-Manuel Anaya Journal: Lupus Sci Med Date: 2015-12-01