ABSTRACT
O lúpus eritematoso sistêmico (LES) é uma doença inflamatória multissistêmica, na qual as infecções são responsáveis por altos índices de morbimortalidade. Os usos de corticóide e imunossupressores contribuem para o aumento das infecções. Embora as bactérias sejam os agentes mais comuns, grande variedade de patógenos tem sido relatada. Este artigo descreve um caso de LES em um menino de 15 anos com criptococose disseminada (sistema nervoso central, pulmão e rim) e encefalite tuberculosa presumível. A coexistência de infecção por Cryptococcus e LES é descrita na literatura, mas a associação desta com encefalite tuberculosa é incomum. O risco potencial de infecções em pacientes lúpicos imunossuprimidos deve alertar o médico a adotar estratégias diagnósticas e terapêuticas precoces visando ao espectro ampliado de possíveis patógenos.
Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease, in which infection is responsible for high rates of mortality. The use of corticosteroids and immunosuppressive therapy contributes to this high incidence of infections. Although bacteria are the most common agents, a wide variety of pathogens has been reported. This article reports a case of SLE in a 15 years-old boy with disseminated criptococosis (central nervous system, lungs and kidneys) and presumptive tuberculous encephalitis. The coexistence of infection by Cryptococcus and SLE is described in the literature, but the combination of this with tuberculous encephalitis is uncommon. The potential risk of infection in immunosuppressed SLE patients should alert the physician to adopt early diagnostic and therapeutic strategies aiming at an extended spectrum of pathogens.
Subject(s)
Humans , Male , Adolescent , Cryptococcosis , Encephalitis , Lupus Erythematosus, Systemic , Rheumatic DiseasesABSTRACT
Osteoarticular infection caused by lt i gt Histoplasma capsulatum lt i gt is rare in Rheumatoid Arthritis (RA) making its diagnosis difficult. In the immunocompetent individuals this infection is autolimited or localized, while in immunodepressed patients the infection may be disseminated, and represents the reactivation of latent focuses or exogenous acquisition. Fungemia occurs in 20% of the cases; bones and joints are involved in 15%, being the spine the most common site of infection. We describe a clinical case of a woman with RA and spondylodiscitis caused by Histoplasma capsulatum with an initial diagnosis of vertebral tuberculosis. The complications of the treatment with amphotericin B, such as, vomiting and severe hypokalemia, led to several interruptions in the medication causing the spread of the pathogen into the liver and lungs.
