Pediatr Nephrol. 2009;24:1337-1343

Prior history of treatment with pulse methylprednisolone may increase the risk of fatal infection in pediatric lupus nephritis (LN) patients treated with IV cyclophosphamide (IVCY), researchers reported.

The investigators studied 64 cases of severe infection in 31 patients treated over an 11-year period (1996-2007) at a referral institution in southern Thailand. The infections were fatal in 13 patients (41.9%). Eleven of these deaths resulted from the first infective episode.

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Fungi and gram-negative bacilli were the major causative pathogens. Prior treatment with pulse methylprednisolone was associated with an 11.2 times increased risk of a fatal infection after adjusting for potential confounders. Fungal infections and renal failure were associated with a nearly 24-fold and sixfold increased risk of death, respectively.

Children with active LN who have been treated with IVCY and pulse methylprednisolone and later develop a severe infection that fails to respond to antibiotics should be carefully investigated for fungal infection, the authors concluded.