Background/Purpose:  The risk of Herpes Virus infections, both Varicella Zoster virus (VZV) and Herpes simplex virus (HSV), is not known in Systemic Lupus Erythematosus (SLE). This study was initiated to establish the prevalence of HSV & VZV infections in hospitalized SLE patients.

Methods:   This is a retrospective cohort study evaluating the prevalence of VZV and HSV in SLE patients hospitalized at Columbia University Medical Center-New York Presbyterian Hospital. Data from electronic medical records (EMR) were obtained from the Columbia University Medical Center (CUMC) Clinical Data Warehouse between January 2000 and September 2014. A total of 2,013 hospitalized patients were identified in the Data Warehouse as having SLE using a validated method. Patients were classified as having SLE based on the International Classification of Diseases, Ninth Revision (ICD-9) codes, using 2 or more SLE ICD-9 code (710.0 and/or 695.4) or at least 1 SLE ICD-9 code and a nephritis (582 or 583 and subtypes); this method has a positive predictive value for SLE of 0.88. Herpetic zoster infections were identified using ICD-9 code 053 (and subtypes) on discharge diagnosis. Herpes simplex infections were identified using ICD-9 code 054 (and subtypes) on discharge diagnosis.

Results:  Of the 2,013 hospitalized SLE patients; there were 59 cases of varicella zoster and 129 cases of herpes simplex. Of the 59 patients with VZV, 28 had complicated zoster infection. Of these cases, 12 patients had CNS zoster, 6 patients had ophthalmic zoster, and 10 patients had disseminated zoster. There was one death from disseminated zoster. Of the 129 HSV cases, one patient had HSV meningitis, 5 patients had ophthalmic HSV infection, 56 patients with oral and/or genital ulcers, and 67 patients had unspecified HSV infections as a discharge diagnosis. Based on these data the prevalence of varicella zoster in SLE was 2.93% and HSV was 6.41%; with a 9.34% overall prevalence of herpetic infections.

Conclusion:   The risk of herpetic infections in SLE is 9.34% in a cohort of hospitalized SLE patients with one death from disseminated zoster. Our data suggest that HSV/VZV is not uncommon in SLE and mortality from complicated VZV is high. SLE patients admitted with a vesicular rash or meningeal symptoms should be evaluated for VZV and have a low threshold for initiating anti-viral treatment. The data is insufficient to substantiate the recommendation for prophylactic use of antiviral treatment in SLE except for high-risk patients with recurrent infections. However, we believe the data presented here further substantiates the need for VZV vaccination in SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/herpetic-viruses-in-lupus/