POS1463 TUBERCULOSIS AS A FATAL OUTCOME IN PATIENTS WITH RHEUMATIC DISEASES: AN AUTOPSY-BASED STUDY

Background

Tuberculosis (TB) is still a worldwide health problem and patients with rheumatic disease (RD) have an increased risk of this infection and fatal outcomes.

Objectives

We aim to report an autopsy case series in patients with an RD whose deaths were caused by TB in a high-level hospital of the Colombian north-east and stress the importance of autopsy as a teaching and research tool.

Methods

A retrospective, descriptive study of the database from the Pathology Department at UIS in Bucaramanga, Colombia. A total of 3390 autopsies were performed between January 2009 and December 2019 in patients whose death occurred at Hospital Universitario de Santander. A total of 1713 autopsy reports were analyzed, of which 10 corresponded to patients with RD whose deaths were caused by Mycobacterium tuberculosis.

Results

A total of 12 patients with a premortem diagnosis of RD were included who additionally had autopsy findings consistent with a mortal infection by a Mycobacterium tuberculosis. Nine cases (75%) were male and 3 were female (25%). The mean age was 49 years old with a range from 32 to 69 years old. The most common RD was rheumatoid arthritis (33,3%) followed by systemic lupus erythematosus, dermatopolymyositis and gouty arthritis with 2 cases (16,6%) each one. In 9 cases the autopsy findings were extrapulmonary TB, of which more than half were disseminated and only 3 cases were exclusively pulmonary TB. All patients were receiving immunosuppressive therapy. The most commonly used therapies were prednisone (100%), methotrexate (25%), and anti-TNF agents (16,6%). A detailed description of the reported cases is displayed in Table 1 and Figure 1.

Table 1.

Description of the reported cases

CaseSexAgeRDISTAutopsy findings1Male32RAPRED, MTX, Anti-TNFDisseminated tuberculosis2Male37DMPMPREDDisseminated tuberculosis3Female42SLEPREDDisseminated tuberculosis4Male43DMPMPRED, MTXPulmonary tuberculosis5Male45GAPREDMeningeal tuberculosis6Male45RAPREDMeningeal tuberculosis7Male49GAPREDPulmonary tuberculosis8Male53PVPRED, AZAPulmonary tuberculosis9Female56RAPRED, Anti-TNFMiliary tuberculosis10Male57SLEPREDDisseminated tuberculosis11Male60RAPRED, MTXPulmonary tuberculosis and tuberculous endocarditis12Female69SScPREDPulmonary and meningeal tuberculosis

RD= Rheumatic Disease; RA= Rheumatoid Arthritis; DMPM= Dermatopolymyositis; SLE= Systemic Lupus Erythematosus; GA= Gouty Arthritis; PV= Pemphigus Vulgaris; SSc= Systemic Sclerosis; IST= Immunosuppressive therapy; PRED= Prednisone; MTX= Methotrexate; Anti-TNF= Tumor Necrosis Factor Inhibitor; AZA= Azathioprine.

Figure 1.

Pictures of some autopsy findings of the reported cases

Conclusion

TB remains one of the leading causes of death worldwide and patients with RD have an increased risk of TB as compared to the general population. In patients with rheumatic conditions, TB most commonly presents in its extrapulmonary form likely from the reactivation of latent infection, hence we stress the importance of screening for the most prevalent infections before the initiation of immunosuppressive therapy. The diagnosis and early treatment of latent TB infection are vital to preventing the progression of the disease and avoid fatal outcomes related to this infection.

References

[1]Hsu C-Y, et al. Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study. Arthritis Res Ther. 2019 Dec12;21(1):211.

[2]Faria R, et al. Opportunistic Infections and Autoimmune Diseases. Infection and Autoimmunity. Elsevier; 2015. p. 251–77.

Disclosure of Interests

None declared

POS1462 CAUSES OF DEATH IN PATIENTS WITH RHEUMATIC AND AUTOIMMUNE DISEASES: A 15-YEAR-OLD AUTOPSY-BASED STUDY

Background

Patients with rheumatic and autoimmune diseases have susceptibility to fatal outcomes and may seem less deadly than they actually are.

Objectives

To describe the main causes of death as determined by autopsy findings, in patients with rheumatic and autoimmune diseases in a central hospital of the Colombian north-east. Stress the importance of autopsy as a teaching, research tool and education in medicine.

Methods

A retrospective, descriptive study of the database from the Pathology Department at UIS in Bucaramanga, Colombia. A total of 4,430 autopsies were performed between January 2004 and December 2019 in patients whose death occurred at Hospital Universitario de Santander or other hospitals in the Bucaramanga metropolitan area. Perinatal autopsy cases were excluded (2,181) and 2,249 autopsy protocols were analyzed, of which 47 corresponded to patients with a rheumatic and autoimmune disease (Figure 1).

Figure 1.

Flowchart of case selection

Results

A total of 47 cases were included, 27 (57.5%) were female and 20 (42.5%) were male. The mean age was 39 years old with a range from 13 to 69 years old. The most common disease was systemic lupus erythematosus (40.5%) and rheumatoid arthritis (29.8%), followed by autoimmune hepatitis and gouty arthritis with 3 cases (6.4%) each one. The most common cause of death determined by the autopsy findings was infections (66%) of which more than half were due to opportunistic pathogens, with tuberculosis being the predominant cause with 12 cases. The second cause was organic compromise due to disease activity (23.4%), and lastly other causes (10.6%) such as pulmonary embolism or myocardial infarction, which conditions more likely to present in patients with a rheumatic and autoimmune disease. A detailed description of the case series is displayed in Table 1. Almost all patients were receiving immunosuppressive therapy. The most used agents were prednisone (85%), methotrexate (19%), and azathioprine (15%). The other immunosuppressive medications were cyclophosphamide and tumor necrosis factor inhibitors in 2 cases each one.

Table 1.

Causes of death determined at autopsies findings.

Disease n (%) Cause of deathSLE 19 (40,5)RA 14 (29,8)AH 3 (6,4)GA 3 (6,4)SSc 2 (4,2)DMPM 2 (4,2)GS 2 (4,2)Others* 2 (4,2)Pneumonia (CAP)5 (26,2)3 (21,4)1 (33,3)-1 (50)---Septic shock2 (10,5)2 (14,3)------Opportunistic Infection5 (26,2)6 (42,9)-2 (66,6)1 (50)2 (100)-1 (50)Renal failure3 (16)-----2 (100)-Respiratory failure--------Hepatic failure--2 (66,6)----1 (50)MODS3 (16)-------Pulmonary embolism1 (5,1)1 (7)------Myocardial infarction-2 (14,3)-1 (33,3)----

*Others: Primary biliary cholangitis 1 case and Pemphigus vulgaris 1 case.

SLE= Systemic lupus erythematosus; RA= Rheumatoid arthritis; AH= Autoimmune Hepatitis; GA= Gouty Arthritis; SSc= Systemic sclerosis; DMPM= Dermatopolymyositis; GS= Goodpasture Syndrome; CAP= Community-acquired Pneumonia; OI= opportunistic infections; MODS= Multiple organ dysfunction syndrome.

Conclusion

The causes of death in our autopsy series match previous studies in these population. The leading cause of death were infections and most cases occurred in young and middle-aged women. These results support previous reports regarding the importance of infections as a cause of death in patients with rheumatic and autoimmune diseases and the fatal outcomes of a severe activity of the uncontrolled disease. It is a challenge for the clinician to treat patients with these conditions and to achieve a balance between obtaining an effective treatment (usually high doses of immunosuppressive drugs) and minimizing the risks of adverse events related to the medications, such as infections.

References:

[1]Mitratza M, et al. Systemic autoimmune disease as a cause of death: mortality burden and comorbidities. Rheumatology (Oxford). 2021;60(3):1321–30.

[2]Garen T, et al. Mortality and causes of death across the systemic connective tissue diseases. Rheumatol UK. 2019;58(2):313–20.

Disclosure of Interests

None declared

Magnetic properties of the double perovskites Sm2Mn1+x Co1-x O6 (x = 0, 0.05, 0.12 and 0.26)

The magnetic properties of the double perovskites Sm₂Mn_1+x Co_1-x O₆ (x  =  0, 0.05, 0.12 and 0.26) were investigated. It was found that the Curie temperature, the lattice parameters and the net magnetic moments increased for increasing amounts of Co. An irreversible behavior was observed by measuring the magnetization after cooling the sample with and without applied magnetic fields (H). The temperature below which the irreversibility was observed is H dependent and the data were nicely fit to de Almeida-Thouless lines. The ac magnetic susceptibility was measured for frequencies f  in the range 0.03-10 kHz yielding [Formula: see text] for the shifting in the freezing temperature per decade of f . The spin-dynamics were found to follow a power-law with a product of the critical exponents [Formula: see text] of about 4.99. The overall results are understood within a framework where the variation in the bonding angle associated to the super-exchange interactions are taken into consideration.