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Background <p>Nocardiosis is a rare but life-threatening opportunistic infection in systemic lupus erythematosus (SLE), although data on childhood-onset SLE remain scarce. The objectives of this study were to determine the prevalence, clinical features, associated factors, and outcomes of nocardiosis in cSLE.</p> Methods <p>A retrospective cohort study was conducted in a tertiary academic center including cSLE patients followed between January 2009 and August 2024. Culture-confirmed nocardiosis cases were identified through systematic review of electronic medical records. Firth penalized logistic regression was used to explore baseline factors associated with the development of nocardiosis.</p> Results <p>Seven out of 323 patients (2.2%) developed culture-confirmed nocardiosis. All were female with a mean age at diagnosis of 11.9 ± 3.1 years. The median (interquartile range) duration from cSLE diagnosis to nocardiosis diagnosis was 4.3 (2.1–13.4) months, with 71.4% occurring within the first year. All patients were receiving corticosteroids at a mean prednisolone-equivalent dose of 1.7 ± 1.3&#xa0;mg/kg/day at the time of infection. The respiratory tract involvement manifesting as pneumonia was the most common infection site (71.4%). Proliferative lupus nephritis had an exploratory association with nocardiosis (OR 5.03, 95% CI 1.19–28.36, <i>p</i> = 0.028). Rapidly progressive glomerulonephritis at initial SLE diagnosis was significantly more frequent in the nocardiosis group (28.6% vs. 4.4%, <i>p</i> = 0.014). Carbapenem-based induction followed by trimethoprim-sulfamethoxazole (TMP/SMX) consolidation was used in the majority of patients. The in-hospital mortality rate from the index nocardiosis episode was 0%, and the 12-month all-cause mortality rate was 14.3%, attributable to secondary <i>Corynebacterium</i> septicemia in the patient with the most multiple immunosuppressive drug therapy with cumulative burden.</p> Conclusion <p>Nocardiosis affects 2.2% of cSLE patients and occurs predominantly early in the disease course. Proliferative lupus nephritis had an exploratory association with nocardiosis, highlighting the need for heightened clinical vigilance and the use of antimicrobial susceptibility testing to guide management in high-risk patients.</p>

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Clinical features and outcomes of nocardiosis in Thai patients with childhood-onset systemic lupus erythematosus

  • 期刊论文

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  • 发表日期：

    2026年7月28日

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  • Sirikarn Tangcheewinsirikul,
  • Sirin Nuntasri,
  • Supattra Rungmaitree,
  • Nuntawan Piyaphanee,
  • Sirirat Charuvanij,
  • Maynart Sukharomana

摘要

Background

Nocardiosis is a rare but life-threatening opportunistic infection in systemic lupus erythematosus (SLE), although data on childhood-onset SLE remain scarce. The objectives of this study were to determine the prevalence, clinical features, associated factors, and outcomes of nocardiosis in cSLE.

Methods

A retrospective cohort study was conducted in a tertiary academic center including cSLE patients followed between January 2009 and August 2024. Culture-confirmed nocardiosis cases were identified through systematic review of electronic medical records. Firth penalized logistic regression was used to explore baseline factors associated with the development of nocardiosis.

Results

Seven out of 323 patients (2.2%) developed culture-confirmed nocardiosis. All were female with a mean age at diagnosis of 11.9 ± 3.1 years. The median (interquartile range) duration from cSLE diagnosis to nocardiosis diagnosis was 4.3 (2.1–13.4) months, with 71.4% occurring within the first year. All patients were receiving corticosteroids at a mean prednisolone-equivalent dose of 1.7 ± 1.3 mg/kg/day at the time of infection. The respiratory tract involvement manifesting as pneumonia was the most common infection site (71.4%). Proliferative lupus nephritis had an exploratory association with nocardiosis (OR 5.03, 95% CI 1.19–28.36, p = 0.028). Rapidly progressive glomerulonephritis at initial SLE diagnosis was significantly more frequent in the nocardiosis group (28.6% vs. 4.4%, p = 0.014). Carbapenem-based induction followed by trimethoprim-sulfamethoxazole (TMP/SMX) consolidation was used in the majority of patients. The in-hospital mortality rate from the index nocardiosis episode was 0%, and the 12-month all-cause mortality rate was 14.3%, attributable to secondary Corynebacterium septicemia in the patient with the most multiple immunosuppressive drug therapy with cumulative burden.

Conclusion

Nocardiosis affects 2.2% of cSLE patients and occurs predominantly early in the disease course. Proliferative lupus nephritis had an exploratory association with nocardiosis, highlighting the need for heightened clinical vigilance and the use of antimicrobial susceptibility testing to guide management in high-risk patients.