Severe infections in plasmapheresis-treated systemic lupus erythematosus

Objective. To assess the risk of infection in patients with systemic lupus erythematosus (SLE) treated with plasmapheresis in addition to intravenous (IV) pulse cyclophosphamide (CYC). Methods. We searched the records of all our SLE patients for those who had undergone plasmapheresis plus IV CYC treatment (n = 9), Consecutive patients with similarly high SLE activity who underwent IV CYC therapy but not plasmapheresis were included as controls (n = 12). We evaluated both groups for severe infections, outcome, and confounding clinical variables. Results. Seven of 9 plasmapheresis-treated patients had serious bacterial or viral infections, including 3 cases of cytomegalovirus infections. Among the 12 patients treated with IV CYC alone, only 2 had severe infections (P < 0.01). Three patients in the plasmapheresis group and none in the control group died of infections. Treatment efficacy, however, was similar for both groups. Conclusion. Among SLE patients treated with plasmapheresis and IV CYC, life-threatening bacterial and viral infections and mortality occur more frequently than among patients with similarly active SLE treated with IV CYC alone.