RESUMO
Our objective was to compare the pattern of organ dysfunctions and outcomes of critically ill patients with systemic lupus erythematosus (SLE) with patients with other systemic rheumatic diseases (SRD). We studied 116 critically ill SRD patients, 59 SLE and 57 other-SRD patients. The SLE group was younger and included more women. Respiratory failure (61 percent) and shock (39 percent) were the most common causes of ICU admission for other-SRD and SLE groups, respectively. ICU length-of-stay was similar for the two groups. The 60-day survival adjusted for the groups’ baseline imbalances was not different (P = 0.792). Total SOFA scores were equal for the two groups at admission and during ICU stay, although respiratory function was worse in the other-SRD group at admission and renal and hematological functions were worse in the SLE group at admission. The incidence of severe respiratory dysfunction (respiratory SOFA >2) at admission was higher in the other-SRD group, whereas severe hematological dysfunction (hematological SOFA >2) during ICU stay was higher in the SLE group. SLE patients were younger and displayed a decreased incidence of respiratory failure compared to patients with other-SRDs. However, the incidences of renal and hematological failure and the presence of shock at admission were higher in the SLE group. The 60-day survival rates were similar.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Hematológicas/epidemiologia , Falência Renal Crônica/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Insuficiência de Múltiplos Órgãos/mortalidade , Transtornos Respiratórios/epidemiologia , Doenças Reumáticas/complicações , Estado Terminal , Métodos Epidemiológicos , Doenças Hematológicas/etiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva , Falência Renal Crônica/etiologia , Tempo de Internação/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/mortalidade , Transtornos Respiratórios/etiologia , Doenças Reumáticas/classificação , Doenças Reumáticas/mortalidadeRESUMO
Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20 percent-40 percent and the relapse rate is as high as 50 percent; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.