1/24. mycobacterium haemophilum infection in an SLE patient on mycophenolate mofetil.We describe a case of mycobacterium haemophilum in an immunocompromised patient with systemic lupus erythematosus (SLE). mycobacterium haemophilum is a recently described pathogen which has not been previously described either in SLE patients or patients on Mycophenolate Mofetil. mycobacterium haemophilum can be difficult to diagnose, as it may not have the granulomas characteristic of atypical mycobacterial infections. Combination therapy with at least two drugs for several months is required and the outcome depends on the patient's underlying immunocompromised state. Our report highlights the need for early diagnosis and treatment of mycobacterium haemophilum in immunocompromised patients with SLE.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
2/24. When typical is atypical: mycobacterial infection mimicking cutaneous vasculitis.patients with systemic lupus erythematosus (SLE) who present with skin disease pose the clinician with diagnostic challenges. The skin disease can reflect an increase in systemic disease activity suggested by other features of active lupus and, as such, usually responds well to more aggressive immunosuppressive therapy. Other possibilities of skin disease include drug eruptions, skin disease unrelated to SLE and, more rarely, opportunistic skin infection. In patients who show a poor response to more aggressive immunosuppressive therapy, consideration must be given to the possibility of opportunistic infection. A high index of suspicion will allow prompt treatment. We describe two patients with SLE who developed cutaneous atypical mycobacterial infection during immunosuppressive therapy. The diagnosis of cutaneous vasculitis was considered in both cases, but subsequent skin biopsy revealed the correct diagnosis. This report illustrates the importance of skin biopsy in patients with suspected cutaneous lupus who are not responding to immunosuppressive therapy.- - - - - - - - - - ranking = 5keywords = bacterial infection (Clic here for more details about this article) |
3/24. mycobacterium kansasii infection presenting as cellulitis in a patient with systemic lupus erythematosus.The prevalence of mycobacterial infection has increased in recent years, especially in patients immunocompromised due to autoimmune disease, malignancy and AIDS. mycobacterium kansasii infection most commonly presents as tuberculosis-like pulmonary disease. We report the case of a 38-year-old woman with systemic lupus erythematosus (SLE) who developed cellulitis over the left lower leg and had poor response to antibiotics. Two months before this admission, she had sustained a small wound over the right pretibial area and had noticed erythematous swelling after swimming at the beach. Pathologic examination of biopsied tissue showed acid-fast bacilli, and culture yielded M. kansasii. The cellulitis improved gradually during treatment with antimycobacterial agents for 1 year. This case emphasizes the possibility that cutaneous M. kansasii infection may occur in an immunocompromised patient and that exposure to contaminated water is a possible source. With early diagnosis, the response to an antimycobacterial multidrug regimen is usually satisfactory.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
4/24. Systemic lupus erythematosus-like autoimmune abnormalities induced by bacterial infection.Recent evidence has revealed that bacterial dna can promote several of the autoimmune abnormalities observed in systemic lupus erythematosus (SLE), and a possible pathogenic role in the induction of SLE has been highlighted. We have recently encountered patients in whom bacterial infection (septicemia) triggered the production of several autoantibodies. This seems to be interesting with respect to the consideration of the relationship between SLE and bacterial infection.- - - - - - - - - - ranking = 6keywords = bacterial infection (Clic here for more details about this article) |
5/24. erythema elevatum diutinum in the setting of connective tissue disease and chronic bacterial infection.erythema elevatum diutinum (EED) is a rare and chronic cutaneous leukocytoclastic vasculitis. It is predominantly seen on the extensor surfaces of the extremities. Although a specific cause is largely unknown, EED has been noted to occur in association with a wide variety of diseases. A 28-year-old man with systemic lupus erythematosus (SLE) and a 53-year-old woman with an overlap syndrome of rheumatoid arthritis and polymyositis are presented. Both patients developed EED in the setting of chronic recurrent bacterial infections. patients with a connective tissue disease are at increased risk for such infections secondary to immunosuppression, either from the disease itself or secondary to immunosuppressive therapy. EED has been independently reported to occur in the setting of connective tissue disease as well as in the setting of chronic infection. Our patients had both of these underlying conditions, which are known to predispose patients to immune complex-mediated vasculitides, in this case EED. One patient's EED responded to treatment of the SLE and the other improved, as has been previously reported with dapsone.- - - - - - - - - - ranking = 5keywords = bacterial infection (Clic here for more details about this article) |
6/24. Increased risk of neisserial infections in systemic lupus erythematosus.survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment. However, infection remains a leading cause of morbidity and mortality in this disease. Although corticosteroids and immunosuppresives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens. As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes. It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis. The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection. They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare. Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections. There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies. The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
7/24. Overwhelming pneumococcal bacteraemia in systemic lupus erythematosus.An 18 year old woman presented with fulminant pneumococcal bacteraemia and subsequently died with multisystem organ failure. A search for diseases predisposing to overwhelming encapsulated bacterial infections was negative except for previously undiagnosed systemic lupus erythematosus (SLE). This case emphasises the severity of immune system dysfunction in some patients with SLE, regardless of immunosuppressive treatment. The possible relation between Fc receptor dysfunction and pneumococcal bacteraemia in SLE is discussed.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
8/24. Serious bacterial cellulitis of the periorbital area in two patients with systemic lupus erythematosus.We describe the occurrence of bacterial cellulitis in the periorbital area of 2 patients with systemic lupus erythematosus (SLE). In both patients the antibacterial activity of polymorphonuclear leucocytes was normal. The opsonic capacity of serum was defective in one patient (corresponding to decreased levels of the 4th component of complement) and normal in the other. Seemingly minor bacterial infections of the skin in patients with SLE should warrant aggressive antimicrobial treatment.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
9/24. pleural effusion in systemic lupus erythematosus.Three cases of systemic lupus erythematosus (SLE) with pleural effusion are reviewed. The characteristics of the effusions are presented, and the literature pertaining to lupus-related effusions is reviewed. There is great heterogeneity in lupus pleural effusions. The presence of polymorphonuclear neutrophils as the predominant white cell, while consistent with SLE, should raise the possibility of complicating bacterial infection. The presence of lupus erythematosus (LE) cells in the fluid seems to be the most specific diagnostic criterion.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
10/24. Panhypogammaglobulinemia in systemic lupus erythematosus: in vitro demonstration of multiple cellular defects.Classically, systemic lupus erythematosus (SLE) is a disease of antibody overproduction, whereas the hallmark of acquired immune deficiency is antibody underproduction. Two patients are presented in whom panhypogammaglobulinemia developed during the course of SLE. In both patients, the levels of the major immunoglobulin (Ig) classes did not fall simultaneously. Anti-dna antibodies were present, and exacerbations of SLE nephritis occurred in both cases 6 to 8 yr after Ig levels became subnormal. One patient still requires immunosuppressive therapy for renal disease; both patients are experiencing recurrent sinopulmonary bacterial infections. In the pokeweed mitogen--stimulated Ig biosynthesis assay, both patients showed abnormal Ig production due to defective function of three cell types: hyporesponsive B cells, excessive T suppression, and subnormal T help. The latter defect is rare in common variable hypogammaglobulinemia. One patient also showed extreme suppression of Ig production by phagocytic mononuclear cells. Thus, despite the similarity in the histories, the cellular function of these two patients was not identical in vitro.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
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