PDF(Pubmed)
Abstract：
BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease, which is mainly characterized by joint swelling, pressure pain and joint destruction. Some patients may suffer from a variety of serious complications, which require prompt diagnosis and treatment. Otherwise, the patient condition may deteriorate rapidly, leading to premature death.
OBJECTIVE: We reported a case of RA combined with hyperferritinemic syndrome and capillary leak syndrome (CLS) that was successfully treated with tocilizumab (TCZ), with the aim of improving diagnostic ideas for clinicians and consequently improving the diagnosis and treatment of the hyperferritinemic syndrome and CLS.
METHODS: A 55-year-old female patient was admitted to the Department of Infectious Diseases of our hospital due to \"recurrent fever for more than 1 month and aggravation for 3 days.\" The patient was diagnosed with fever of unknown origin (lung infection?) and received anti-infective therapy with large encirclement of anti-bacterial, antifungal and empirical anti-tuberculosis successively during hospitalization in the Department of Infectious Diseases. Yet her condition continues to progress. The patient was eventually diagnosed with RA combined with hyperferritinemic syndrome and CLS. Then she received glucocorticoids (GC) (160 mg qd) combined with intravenous immunoglobulin (IVIG, 20 g/d, for 3 days). We considered that the patient also had an overwhelming proinflammatory cytokine storm, so she received a strong anti-inflammatory treatment with TCZ (400 mg qm). The patient symptoms and follow-up chest CT showed significant improvement following treatment.
CONCLUSIONS: TCZ has good efficacy in the treatment of RA combined with hyperferritinemic syndrome and CLS and is expected to be a promising treatment.
OBJECTIVE: We reported a case of RA combined with hyperferritinemic syndrome and capillary leak syndrome (CLS) that was successfully treated with tocilizumab (TCZ), with the aim of improving diagnostic ideas for clinicians and consequently improving the diagnosis and treatment of the hyperferritinemic syndrome and CLS.
METHODS: A 55-year-old female patient was admitted to the Department of Infectious Diseases of our hospital due to \"recurrent fever for more than 1 month and aggravation for 3 days.\" The patient was diagnosed with fever of unknown origin (lung infection?) and received anti-infective therapy with large encirclement of anti-bacterial, antifungal and empirical anti-tuberculosis successively during hospitalization in the Department of Infectious Diseases. Yet her condition continues to progress. The patient was eventually diagnosed with RA combined with hyperferritinemic syndrome and CLS. Then she received glucocorticoids (GC) (160 mg qd) combined with intravenous immunoglobulin (IVIG, 20 g/d, for 3 days). We considered that the patient also had an overwhelming proinflammatory cytokine storm, so she received a strong anti-inflammatory treatment with TCZ (400 mg qm). The patient symptoms and follow-up chest CT showed significant improvement following treatment.
CONCLUSIONS: TCZ has good efficacy in the treatment of RA combined with hyperferritinemic syndrome and CLS and is expected to be a promising treatment.
摘要：
背景：类风湿性关节炎（RA）是一种慢性系统性自身免疫性疾病，其主要特征是关节肿胀，压力疼痛和关节破坏。一些患者可能患有各种严重的并发症，需要及时诊断和治疗。否则,患者病情可能会迅速恶化，导致过早死亡。
目的：我们报道了1例RA合并高铁蛋白血症和毛细血管渗漏综合征（CLS）的病例，该病例采用托珠单抗（TCZ）治疗成功，目的是改善临床医生的诊断思路，从而改善高铁蛋白综合征和CLS的诊断和治疗。
方法：我院感染科收治1例55岁女性患者，因“反复发热1个月以上，加重3天。“患者被诊断为不明原因发热（肺部感染？），并接受了大包围抗菌的抗感染治疗，在感染科住院期间先后进行抗真菌和经验性抗结核治疗。然而，她的病情仍在继续发展。患者最终被诊断为RA合并高铁蛋白血症综合征和CLS。然后，她接受了糖皮质激素（GC）（160mgqd）联合静脉注射免疫球蛋白（IVIG，20g/d,3天）。我们认为患者也有一个压倒性的促炎细胞因子风暴，因此，她接受了TCZ（400mgqm）的强力抗炎治疗。治疗后，患者症状和随访胸部CT显示显着改善。
结论：TCZ治疗RA合并高铁蛋白血症综合征和CLS的疗效较好，有望成为一种有前途的治疗方法。
目的：我们报道了1例RA合并高铁蛋白血症和毛细血管渗漏综合征（CLS）的病例，该病例采用托珠单抗（TCZ）治疗成功，目的是改善临床医生的诊断思路，从而改善高铁蛋白综合征和CLS的诊断和治疗。
方法：我院感染科收治1例55岁女性患者，因“反复发热1个月以上，加重3天。“患者被诊断为不明原因发热（肺部感染？），并接受了大包围抗菌的抗感染治疗，在感染科住院期间先后进行抗真菌和经验性抗结核治疗。然而，她的病情仍在继续发展。患者最终被诊断为RA合并高铁蛋白血症综合征和CLS。然后，她接受了糖皮质激素（GC）（160mgqd）联合静脉注射免疫球蛋白（IVIG，20g/d,3天）。我们认为患者也有一个压倒性的促炎细胞因子风暴，因此，她接受了TCZ（400mgqm）的强力抗炎治疗。治疗后，患者症状和随访胸部CT显示显着改善。
结论：TCZ治疗RA合并高铁蛋白血症综合征和CLS的疗效较好，有望成为一种有前途的治疗方法。
