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Rheumatology Advance Access published online on July 22, 2006
Rheumatology, doi:10.1093/rheumatology/kel206
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 13, 2006
Accepted May 12, 2006

Concise Report

Non-tuberculous mycobacterial infection in patients with systemic lupus erythematosus

M. Y. Mok 1 *, S. S. Y. Wong 2, T. M. Chan 1, D. Y. T. Fong 3, W. S. Wong 1, and C. S. Lau 1

1 University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
2 Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
3 Department of Nursing Studies, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China

* To whom correspondence should be addressed.
M. Y. Mok, E-mail: mymok{at}netvigator.com


  Abstract

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.

Keywords: Infection; Immunocompromised host; Mycobacterium; Synovitis.
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