Characterization of patients with lupus and fever: Flares, infection or both

Abstract Objective To describe the clinical characteristics and laboratory findings of patients over 15 years old, diagnosed with Systemic Lupus Erythematosus (SLE) that were hospitalized with fever and with a final diagnosis of infection, lupus flare, or both (disease activity and infection). Methods A retrospective, desriptive study was conducted, including patients with a diagnosis of SLE, who presented with fever and were admitted to the Emergency Department of Hospital Universitario Clinica San Rafael. Clinical and paraclinical variables were analyzed and the patients were divided into three groups: patients with disease flare-up, infection, or both, in accordance with the final diagnosis upon discharge. Clinical and laboratory variables were analyzed, and a description of the population was submitted based on the 3 presentations. Results A total of 115 patients were assesed, and 108 were included in the final analysis. The mean age was 36 years old and 86% were females. The median SLEDAI (Systemic Lupus Erythematous Disease Activity Index) was 6 (R 1-15) for the entire population. In patients with both infection and disease activity, the median score was 9.5 (R 6-15). There were no significant differences betweent the clinical symptoms and the laboratory findings in the various groups. The use of prednisolone during the last 3 months was higher in the infection group (p=0.001), but with no significant differences as compared against other immonusupressive therapies. Conclusion The use of steroids over the last 3 months, the SLEDAI score, and the time elapsed sinde the SLE diagnosis, could be helpful variables to discriminate between infection and disease activity in patients with a history of SLE and fever. The clinical and paraclinical findings fail to discriminate between these two conditions.