Infections Associated with Systemic Lupus Erythematosus: Tackling Two Devils in the Deep Blue Sea

Abstract

Systemic lupus erythematosus (SLE) is a quintessential systemic autoimmune disease with multiorgan involvement. Although its pathology has been elucidated and therapeutic advances are being made, infections remain the leading cause of death in SLE. In addition to immune abnormalities caused by SLE itself, the use of nonspecific glucocorticoids and immunosuppressants during treatment induces a state of immune suppression, increasing the risk of infection. Bacterial infections are the most common, but impaired cell-mediated immunity may also lead to the development of opportunistic infections, as well as viral and fungal infections. When treating SLE, caution is required for the development of infectious complications, such as latent tuberculosis, de novo hepatitis B, Pneumocystis jiroveci pneumonia (PJP), herpes zoster, and cytomegalovirus infection. Vaccination is recommended for vaccine-preventable diseases for appropriate management of infections. For other infectious diseases, such as tuberculosis, PJP, and disseminated herpes zoster, adequate treatment is necessary.