Major infections in a cohort of 120 patients with juvenile-onset systemic lupus erythematosus

- The most common major infections in jSLE are skin and soft tissue infections, pneumonias and urinary tract infections with fever.
- Major infections are responsible for considerable morbidity in jSLE.
- jSLE activity and its treatment contribute to the risk of major infection.
- Judicious use of immunosuppressive drugs is essential to reduce major infections.

In order to describe the incidence and characteristics of major infections in juvenile-onset systemic lupus erythematosus (jSLE), we studied a cohort of 120 patients (51% Hispanic and 28% African American, 49% with renal involvement and 12% with neuropsychiatric manifestations). There were 101 major infections affecting 44 patients (37%) for an incidence of 169/1000 patient-years of follow-up. Active disease at jSLE diagnosis, renal involvement, neuropsychiatric manifestations, higher cumulative dose of prednisone, and treatment with cyclophosphamide or mycophenolate mofetil were all associated with major infection (p < 0.05). By logistic regression, the combined effect of treatment with cyclophosphamide and cumulative dose of prednisone was associated with major infection (p = 0.04). Two patients died, one due to cytomegalovirus infection. Major infection was associated with damage (p = 0.004). In conclusion, in a large cohort of jSLE patients, major infections were common, were associated with active disease and its treatment, and resulted in noteworthy morbidity.