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173 Elderly sle patients with previous skin herpes infection and higher dose of steroid enhanced the risk of severe herpes simplex infection: a nationwide study
  1. TH Li1,2,
  2. YS Chang3,
  3. CC Lai4 and
  4. CY Tsai4
  1. 1Taichung Venterans general hospital – Chiayi branch, Division of Allergy- Immunology- and Rheumatology- Department of Medicine, Chiayi City, Taiwan R.O.C
  2. 2National Yang-Ming University, Institute of Clinical Medicine, Taipei, Taiwan R.O.C
  3. 3Shuang-Ho Hospital- Taipei Medical University, Division of Allergy- Immunology- and Rheumatology- Department of Internal Medicine, New Taipei City, Taiwan R.O.C
  4. 4Taipei Veterans General Hospital, Division of Allergy- Immunology- and Rheumatology- Department of Medicine, Taipei City, Taiwan R.O.C


Background and aims Systemic lupus erythematosus (SLE) patients are susceptible to herpes simplex virus (HSV) infection, which is occasional but often leading to overwhelming disease such as encephalitis and keratitis. However, only few attempts have been made at the associated incidence and risk factors.

Methods We enrolled SLE patients from the Taiwanese National Health Insurance research database between 1997 and 2012. We compared the incidence rate (IR) of severe HSV infection, including viral septicemia, meningoencephalitis, ocular infection, visceral infection and those with complications after infection, with those of non-SLE cohort. We also evaluated the risk factors of severe HSV infection by means of Cox multivariable proportional hazards model.

Results A total of 1 22 520 subjects (24 504 SLE patients and 98 016 age- and gender-matched subjects as control group) were analysed and revealed a significantly higher IR of severe HSV infection in SLE (Incidence rate ratio=3.52, p<0.001). Previous skin infection (HR=2.17, p=0.047), intravenous steroid pulse therapy (HR=4.48, p<0.001), oral daily steroid dose over 7.5 mg prednisolone or equivalent (HR=1.60, p=0.010) were independent risk factors for severe HSV infection in SLE patients, while age ≤18 (HR=0.47, p=0.021) was a protective factor.

Conclusions A higher risk of severe HSV infection was observed in SLE patients The risk factors for severe HSV infection were age over 18, previous skin infection, intravenous steroid pulse therapy and an oral daily steroid dose over 7.5 mg.

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