Septic arthritis in patients with systemic lupus erythematosus: salmonella and nonsalmonella infections compared.

OBJECTIVES: To assess the clinical characteristics and outcome of systemic lupus erythematosus (SLE) with septic arthritis. METHODS: In this 20-year retrospective study, we reviewed the charts of SLE patients with septic arthritis confirmed by synovial fluid analysis and culture. To identify risk factors for septic arthritis, data of SLE patients with septic arthritis were compared with data of 100 hospitalized SLE patients without septic arthritis. RESULTS: There were 10,732 inpatient records of 3,127 SLE patients; 29 SLE patients had septic arthritis. Their ages ranged from 14 to 68 years (mean, 35.1 +/- 14.1 years). The mean SLE duration before septic arthritis onset was 30.6 months. All patients received corticosteroids; 93% had active disease (SLEDAI > or = 4). Compared with controls, avascular necrosis (AVN) of the femoral head was the most common predisposing articular disease (Odds ratio, 3.799;CI, 1.59 to 9.05). Of the 29 patients, 17 (59%) had salmonella infections and 12 (41%) had other infections. Salmonella-infected patients were younger (28.7 +/- 10.4 years) than those with nonsalmonella infections (44.1 +/- 14.0 years; P = 0.002). The hip was the most commonly affected joint, especially in the salmonella group, followed by the knees and ankles. Salmonella-infected patients were more prone to oligo-articular septic arthritis. The overall mortality rate was 10%. CONCLUSIONS: Salmonella enteritidis B is the most common pathogen causing septic arthritis in younger SLE patients. Septic arthritis tended to be oligo-articular and involve the hip joint. AVN of the femoral head was the most common predisposing articular disease. Once septic arthritis is suspected, culture specimens should be collected and appropriate antibiotics given immediately.

The clinical differences between early-and late-onset pulmonary hemorrhage in systemic lupus erythematosus patients.

BACKGROUND: Pulmonary hemorrhage (PH) is a rare but possible fatal complication of systemic lupus erythematous (SLE). We try to better understand the clinical symptoms and prognosis in patients with SLE and PH. Furthermore, we want to know whether there is different between early-onset and late-onset pulmonary hemorrhage in SLE patients. METHODS: A retrospective review was carried out for all medical admissions of 3128 patients with the diagnosis of SLE at Chang Gung Medical Center from 1994 to 2003. Twenty SLE patients with PH were carefully reviewed. For all study subjects, the patient demographics, clinical, laboratory, therapeutic, and outcome data were collected and chest radiographs were reviewed. Seven of 20 patients with PH occurred earlier as one of the initial manifestations of SLE were subgrouped to early-onset group. The remaining 13 patients with PH were classified as late-onset group. RESULTS: During the 10-year period, there were 20 patients (16 females and 4 males) who had suffered from PH. The age distribution was between 13.2 and 55 years, (median age 25.5 years). The most predominant symptoms and signs were hemoptysis, tachypnea, and dyspnea. The patients, initially with low hemoglobin concentration, were prone to death. (mortality group vs survival group was 5.6 +/- 1.4 vs 7.9 +/- 2.0 gm/dL, p value = 0.004). The late-onset group had a higher rate of presenting with cough, and younger onset-age than that in the early-onset group. CONCLUSIONS: Low hemoglobin is a risk factor for mortality in SLE patients with pulmonary hemorrhage. Clinically, the late-onset group was younger than the early-onset group and had higher rate of presenting with cough. No statistical prognostic differences showed between late-onset and early-onset groups.

Etanercept therapy in children with juvenile rheumatoid arthritis.

Etanercept is an effective inhibitor of tumor necrosis factor that has shown a beneficial effect in patients with juvenile rheumatoid arthritis (JRA) that did not respond to other disease-modifying drugs. Here we report 3 patients with JRA who were refractory to traditional therapy; 1 with systemic JRA and 2 with polyarticular JRA. They received etanercept 0.4 mg/kg (maximum 25 mg) subcutaneously, twice a week for 3 months. The symptoms of arthritis improved significantly except that the patient with systemic JRA had disease flare-up during etanercept therapy. Two patients had upper respiratory tract infection during etanercept therapy and 1 suffered from seizure attack. The 2 patients with polyarticular JRA had disease flare-up within 2 months after etanercept was discontinued. This is the first report of etanercept treatment in JRA patients in Taiwan.

Central nervous system infections in patients with systemic lupus erythematosus.

OBJECTIVE: To evaluate the clinical profiles of patients with systemic lupus erythematosus (SLE) with central nervous system (CNS) infections. METHOD: We retrospectively reviewed patients with SLE with CNS infections from January 1983 to June 2003. The clinical features, laboratory data, and prognoses of these patients were recorded. RESULTS: During the 20-year review period, 17 SLE patients with CNS infections were identified. The mean age at CNS infection was 29.6 +/- 15.3 years. Cryptococcal infection was identified in 10 patients and bacterial meningitis in 7. Most patients (94%) had active SLE at the time of CNS infection. Fifteen patients received corticosteroid therapy and of these, 7 received it in conjunction with immunosuppressive agents. The most common presentation was headache, fever, and vomiting. The mortality rate among the 17 patients was high (41.2%). CONCLUSION: Cryptococcal meningitis played the major role in CNS infection of patients with SLE, and it cannot be ruled out even when the cerebrospinal fluid (CSF) white blood cell count is within normal range. CSF India ink and latex agglutination testing for cryptococcal antigen should be performed and are effective screening tools to establish an early diagnosis.

Pulse methylprednisolone therapy in the treatment of immune globulin-resistant Kawasaki disease: case report and review of the literature.

A subgroup of patients with Kawasaki disease (KD) did not respond to intravenous immune globulin (IVIG) therapy. Corticosteroid therapy remains a controversial alternative in such cases. We report two young children with KD who failed to respond to three courses of IVIG therapy and subsequently received pulse methylprednisolone as an alternative. One had a satisfactory outcome but the other developed giant coronary aneurysms and had a myocardial infarction 2 months after onset of the illness. A review of relevant literature showed that the timing of initiation of pulse methylprednisolone therapy is important. It is suggested that pulse methylprednisolone therapy should be considered if there is no response to two standard doses of IVIG treatment.

Rotavirus gastroenteritis associated with afebrile convulsion in children: clinical analysis of 40 cases.

BACKGROUND: The purpose of this study was to evaluate the clinical manifestations and outcomes of hospitalized children with afebrile seizures following rotavirus gastroenteritis. METHODS: We conducted a retrospective study enrolling patients under 18 years old who were admitted to our hospital during a 10-year period with the diagnosis of rotavirus gastroenteritis. We identified and further analyzed patients who presented with afebrile seizures, without previous seizure disorders, electrolyte imbalances or hypoglycemia. The statistical methods used were the Chi-square test, the Kruskal-Wallis test and the Mann-Whitney test. RESULTS: Of 1937 patients, 40 patients (24 female and 16 male patients) met the inclusion criteria. The incidence of afebrile seizures following rotavirus gastroenteritis was 2.06%. The age of the patients ranged from 6 months old to 6 years old (mean, 1.9 years). The highest incidence of afebrile seizures was 4.67% in children 1 to 2 years of age (p < 0.001). Twenty-seven patients (67.5%) had two or more seizures, which usually were in clusters within a 24-hour period. No status epilepticus was observed. More than half of the patients (52.5%) suffered from seizures on the third day of diarrhea. Only five of 35 patients showed abnormal electroencephalogram (EEG) findings, which reverted to normal in four of the patients during the follow-up period. Most patients did not require long-term anticonvulsant treatment. During the follow-up period, all patients displayed normal psychomotor development without the recurrence of seizures, except in one patient who had a febrile convulsion. CONCLUSION: We found that the course of afebrile seizures following rotavirus gastroenteritis was benign with satisfactory outcomes.