P31 Navigating complex infections in systemic lupus erythematosus: a lupus flare complicated with neutropenic sepsis and a rare fungal infection by Magnusiomyces clavatus

Abstract Introduction Systemic lupus erythematosus (SLE) can predispose patients to infections due to active disease or immunosuppressive treatments. Neutropenic sepsis, which could be caused by either, is a life-threatening condition with a challenging management and can be complicated by opportunistic fungal infections. Here we present a case of a lupus flare complicated by neutropenic sepsis and streptococcal pneumonia followed by a cavitary lung lesion and a rare fungal infection by Magnusiomyces clavatus (formally known as Saphrochaete calavata or Geotrichum calavatum). To our knowledge this is the first reported case of Magnusiomyces clavatus infection in a SLE patient in the United Kingdom. Case description A 32-year-old Caucasian female with a 6-year history of SLE presented 8 weeks post-partum with fever, cough, oral ulcers and joint pains for 2 weeks. She had a lupus flare in her third trimester, and was on prednisolone tapering dose at 10 mg/day, hydroxychloroquine and azathioprine. Her lupus manifestations were limited to mucocutaneus and musculoskeletal manifestations in the past and never had significant renal or neuropsychiatric involvement. On physical examination, she was febrile, ill and confused. She had oral ulcers and active synovitis. She was dyspneic with a saturation of 93% and was tachycardic. There were right upper zone crepitations on auscultation. Investigations revealed profound pancytopenia (WBC 0.1 x 10^9/L, neutrophils 0, hemoglobin 8.9 g/dL, platelets 79 x 10^9/L), raised dsDNA titer (219 IU/ml) and low serum complements. Streptococcus pneumoniae was isolated from blood cultures and CT chest showed dense right upper lobe consolidation. She was diagnosed with lupus flare with neutropenic sepsis and streptococcal pneumonia and managed with intravenous antibiotics, granulocyte colony-stimulating factor (G-CSF), intravenous immunoglobulin, steroids and blood product transfusions. Despite a prolong period of persistent neutropenia, she had a good response to treatment initially. However, after 2 weeks in to her hospital admission her cough worsened with brownish sputum and chest imaging reveled development of a cavitary lesion in the previously consolidated area. Blood cultures isolated Magnusiomyces clavatus fungus, and her beta-D-glucan levels were markedly elevated. However, the bronchoalveolar lavage was negative for the fungus. Notably, she had athletes’ foot which is a known entry for this fungus. She was treated with intr