Double Trouble: A Case of Concurrent Opportunistic Infections

To the Editor: Patients with systemic lupus erythematosus (SLE) are at increased risk of infection. We present the case of a patient with SLE who developed concurrent opportunistic infections while receiving immunosuppressive therapy. A 56-year-old man with a 30-year history of SLE was transferred to our institution from a referring hospital for the evaluation of headaches and change in mental status. His disease had previously been characterized by polyarthritis, serositis, erythematous malar rash, and nephritis. He had received treatment with cyclophosphamide and azathioprine 10 years prior, and was maintained thereafter with hydroxychloroquine 400 mg PO daily with disease stability. In the 2 years preceding this presentation, he had developed recurrent pleurisy and worsening renal dysfunction, and was thus started on treatment with prednisone 15 mg to 25 mg PO daily along with mycophenolate mofetil 720 mg PO twice daily that he received continuously until his hospitalization. Prior to a scheduled visit with his rheumatologist, he presented to his local hospital with 10 days of headache. Upon … Address correspondence to Dr. L. Albert, University Health Network, Toronto Western Hospital - 1E 424, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: lori.albert{at}uhn.ca