OBJECTIVE: To define the clinical spectrum and disease sequelae of herpes zoster and to determine the risk factors associated with the development of herpes zoster in patients with systemic lupus erythematosus (SLE). METHODS: Retrospective matched case control study in a consecutive series of patients with SLE first evaluated between 1979 and 1989. Patients were classified as cases if their first episode of zoster occurred after lupus diagnosis. Lupus patients who never had zoster were eligible as controls and were matched 2:1 to cases for age, race, sex, and survival status. Clinical features of the cases from the time of lupus diagnosis to the time of zoster were compared to their respective controls over similar time periods. RESULTS: Forty eight (15%) of 321 patients were classified as cases. Cases were more likely to have received cyclophosphamide (p = 0.03), and azathioprine (p = 0.006). More cases had lupus nephritis (p = 0.02), and a concurrent or previous malignancy (p = 0.01) than their controls. Seven cases had cutaneous dissemination. Seven patients had postherpetic neuralgia > 2 months and in only 2 patients symptoms persisted for > 12 months' duration. Only 3 of 36 patients had immunosuppressive medication discontinued at the time of diagnosis of zoster, and 10 cases received acyclovir for the zoster infection. There were no permanent neurologic deficits or death. CONCLUSION: Immunosuppressive therapy, specifically cyclophosphamide and azathioprine, lupus nephritis, and a concurrent or previous malignancy may be risk factors for the development of herpes zoster infections in patients with SLE. Our study suggests that although herpes zoster occurs frequently in patients with SLE, it has a relatively benign course. Discontinuing needed immunosuppressive therapy in patients with SLE may be unnecessary in the setting of a zoster infection. With the current emphasis on reduction in medical costs, both by limiting inpatient admissions and eliminating unneeded medications, it is necessary to identify which patients require more intensive therapy with antiviral medications and/or hospitalization and which are likely to have a benign, self-limited course without intervention.
OBJECTIVE: To define the clinical spectrum and disease sequelae of herpes zoster and to determine the risk factors associated with the development of herpes zoster in patients with systemic lupus erythematosus (SLE). METHODS: Retrospective matched case control study in a consecutive series of patients with SLE first evaluated between 1979 and 1989. Patients were classified as cases if their first episode of zoster occurred after lupus diagnosis. Lupus patients who never had zoster were eligible as controls and were matched 2:1 to cases for age, race, sex, and survival status. Clinical features of the cases from the time of lupus diagnosis to the time of zoster were compared to their respective controls over similar time periods. RESULTS: Forty eight (15%) of 321 patients were classified as cases. Cases were more likely to have received cyclophosphamide (p = 0.03), and azathioprine (p = 0.006). More cases had lupus nephritis (p = 0.02), and a concurrent or previous malignancy (p = 0.01) than their controls. Seven cases had cutaneous dissemination. Seven patients had postherpetic neuralgia > 2 months and in only 2 patients symptoms persisted for > 12 months' duration. Only 3 of 36 patients had immunosuppressive medication discontinued at the time of diagnosis of zoster, and 10 cases received acyclovir for the zoster infection. There were no permanent neurologic deficits or death. CONCLUSION: Immunosuppressive therapy, specifically cyclophosphamide and azathioprine, lupus nephritis, and a concurrent or previous malignancy may be risk factors for the development of herpes zoster infections in patients with SLE. Our study suggests that although herpes zoster occurs frequently in patients with SLE, it has a relatively benign course. Discontinuing needed immunosuppressive therapy in patients with SLE may be unnecessary in the setting of a zoster infection. With the current emphasis on reduction in medical costs, both by limiting inpatient admissions and eliminating unneeded medications, it is necessary to identify which patients require more intensive therapy with antiviral medications and/or hospitalization and which are likely to have a benign, self-limited course without intervention.
Authors: Jay R McDonald; Angelique L Zeringue; Liron Caplan; Prabha Ranganathan; Hong Xian; Thomas E Burroughs; Victoria J Fraser; Fran Cunningham; Seth A Eisen Journal: Clin Infect Dis Date: 2009-05-15 Impact factor: 9.079
Authors: Joel M Guthridge; Abigail Cogman; Joan T Merrill; Susan Macwana; Krista M Bean; Tiny Powe; Virginia Roberts; Judith A James; Eliza F Chakravarty Journal: J Rheumatol Date: 2013-09-15 Impact factor: 4.666
Authors: Gilmara Franco da Cunha; Fernando Henrique Carlos de Souza; Maurício Levy-Neto; Samuel Katsuyuki Shinjo Journal: Clinics (Sao Paulo) Date: 2013-05 Impact factor: 2.365