Rheumatology Advance Access originally published online on July 22, 2006
Rheumatology 2007 46(2):280-284; doi:10.1093/rheumatology/kel206
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Non-tuberculous mycobacterial infection in patients with systemic lupus erythematosus
University Department of Medicine, 1Department of Microbiology and 2Department of Nursing Studies, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Correspondence to: Dr Mo Yin Mok, Rheumatologist, Division of Rheumatology, University Department of Medicine, Queen Mary Hospital, Hong Kong, China. E-mail: mymok{at}netvigator.com
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Abstract |
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Objectives. Patients with systemic lupus erythematosus (SLE) are susceptible to opportunistic infections. To examine the clinical manifestations of non-tuberculous mycobacterial (NTM) infections with those of Mycobacterium tuberculosis (MTB) infections in SLE patients.
Methods. Medical records of a cohort of 725 SLE patients were reviewed for previous NTM infections. Demographic characteristics, predisposing factors and clinical outcomes were compared with patients who had previous MTB infections (n = 39).
Results. Eleven (nine female and two male) cases were identified (prevalence 1.5%). The mean ± S.D. age at the time of infection was 42.8 ± 13.9 yrs, 9.3 ± 5.8 yrs after the onset of SLE. The mean ± S.D. time taken from onset of symptoms to the diagnosis of NTM infection was 5.7 ± 7.2 months. Sites of involvement included skin and soft tissue (n = 8), chest (n = 2) and disseminated infection (n = 1). NTM infections were more likely to involve extrapulmonary sites (P = 0.006), presented in patients with longer lupus disease duration (P < 0.001), occurred in older patients (P < 0.001) and in those who had a higher cumulative dose of prednisolone (P = 0.01) than MTB infections. Using a stepwise logistic regression, disease duration was found to be the only independent predictive factor (P = 0.005) for NTM infections. Ten (25.6%) patients with MTB infections but none of the patients with NTM infections presented concomitantly at the onset of SLE (P = 0.09). There were no differences in the recurrence rate (P = 0.64) and frequency of disseminated infections (P = 0.40) between NTM and MTB infections.
Conclusions. NTM infections tended to develop in SLE patients later in their disease course than MTB infections. A high index of suspicion is required for its diagnosis.
KEY WORDS: Infection, Immunocompromised host, Mycobacterium, Synovitis
Submitted 13 February 2006;
revised version accepted 12 May 2006.
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