NOCARDIOSIS IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Objectives: This study was performed to study the clinical presentatio ns, treatment, and outcome of six cases of nocardial infection in the systemic lupus erythematosus (SLE) population living in Hong Kong and compare these cases with those reported in the English literature. Met hods: Records of 215 SLE patients who attended our lupus and rheumatol ogy clinics were reviewed, and cases of nocardial infection were retri eved and studied in detail. A Medline search from 1966 to 1995 was per formed to identify other reported cases. The microbiology, diagnosis, and treatment strategies of nocardiosis were assessed. Results: Six ca ses of nocardiosis were found in our lupus series, giving a prevalence of 2.8%. Another 26 cases of nocardial infection in SLE were reported in the literature. All except one were caused by Nocardia asteroides. The lung was the commonest site of involvement (81%), followed by the central nervous system (CNS) (13%). The mortality was high (35%), esp ecially when the CNS was involved (75%). Sulphonamides were the mainst ay of treatment, and adjunctive surgical procedures may be needed for suppurative complications. Conclusions: Nocardiosis has been increasin gly recognized in SLE. Although still uncommon, it is an important opp ortunistic infection because it is curable and mortality is usually ca used by delay in diagnosis and treatment. A high index of suspicion, a n aggressive approach to diagnosis, and early empirical therapy are es sential principles of management. Copyright (C) 1997 by W.B. Saunders Company.