Mucormycosis in systemic lupus erythematosus.
OBJECTIVE
To describe a case of mucormycosis in systemic lupus erythematosus (SLE) and to review other patients reported in the English literature.


METHODS
A Medline search for articles about mucormycosis in SLE published between 1970 and 2002 was performed by using the key words "lupus," "mucormycosis," "zygomycosis," "Mucorales," "Rhizopus," and "Mucor." Cases were pooled for analysis, and the mycology, diagnosis, treatment, and outcome of mucormycosis in SLE was reviewed.


RESULTS
Eight cases of mucormycosis in SLE were identified (female:male = 7:1). The mean age at the time of infection was 31.8 +/- 7.6 years and the mean duration of SLE was 6.3 +/- 3.9 years. All except 1 patient had active lupus and all were receiving high-dose corticosteroids. Concomitant cytotoxic agents were used in 4 patients. Additional predisposing factors for opportunistic infection included hypocomplementemia, nephrotic syndrome, uremia, leukopenia, and diabetes mellitus. The disseminated form of mucormycosis was the most common presentation and the diagnosis often was made only at autopsy (63%). For cases with positive culture results, Rhizopus was the causative species. In 4 patients, manifestations of the fungal infection mimicked those of active SLE. The overall mortality of mucormycosis was very high (88%) and, in most cases, was probably a function of delayed diagnosis and treatment. The cutaneous form appeared to have the best prognosis with combined medical and surgical treatment.


CONCLUSIONS
Mucormycosis is a rare but usually fatal fungal infection in SLE. Judicious use of immunosuppressive agents, a high index of suspicion, early diagnosis, and combination treatment with amphotericin B and surgical debridement may improve the prognosis of this serious infection.
Mok
Chi Chiu
CC
Departments of Medicine, Microbiology, Radiology, and Pathology, Tuen Mun Hospital, Hong Kong, China. ccmok@netvigator.com
Que
Tak Lun
TL
Tsui
Edmund Yik Kong
EY
Lam
Wing Yin
WY
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D008297:Male; D009091:Mucormycosis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents