title: Disseminated histoplasmosis in systemic lupus erythematosus: case report and review of the literature.
abstract: OBJECTIVE
  To report a patient who developed both central nervous system systemic lupus erythematosus (SLE) and disseminated histoplasmosis and to review the literature regarding histoplasma infection in patients with SLE.
  
  
  METHODS
  MEDLINE review of the medical literature published in English.
  
  
  RESULTS
  Disseminated histoplasmosis occurs rarely in patients with SLE. The main risk factor is treatment with corticosteroids at doses of 20 mg/d or greater. Fever, dyspnea, pleurisy, and weight loss are typical presenting symptoms. The most commonly involved tissues are lung, liver, and bone marrow. In our patient, both SLE flare and disseminated histoplasmosis were present simultaneously.
  
  
  CONCLUSIONS
  Opportunistic infection is an important complication of SLE and may be difficult to diagnose. Symptoms of infection may mimic those of a lupus flare, or conversely, symptoms may be masked by the use of corticosteroids. Fever, unexplained tissue involvement, atypical clinical patterns, and poor response to immunosuppressive therapy should alert the clinician to aggressively pursue evaluation of possible infection in patients with SLE.
authors.affiliation: Division of Rheumatology, Allergy and Clinical Immunology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Hansen
authors.forename: E W
authors.initials: EW
authors.lastname: St Clair
mesh_terms: D005260:Female; D006660:Histoplasmosis / Q000150:complications*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000382:microbiology*; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications*