背景:德维奇综合征是一种罕见的自身免疫性疾病,发生在人体免疫系统损伤并错误地攻击视神经和脊髓时,导致许多神经学。症状,比如炎症,弱点,麻木,和视力问题。利妥昔单抗主要用作Devic综合征患者的免疫抑制治疗。尽管有证据表明利妥昔单抗在治疗Devic综合征患者方面有效且耐受性良好,利妥昔单抗有可能加重严重的银屑病和银屑病性关节炎发作。
方法:在本文中,我们描述了一个58岁女性患有德维奇综合征的病例,失明,以及对利妥昔单抗反应异常好的神经系统受累。然而,她患上了严重的银屑病关节炎。退出使用利妥昔单抗后,她的银屑病关节炎症状已经缓解。然而,她确实又一次失明,利妥昔单抗再次开始。虽然她的视力有所改善,她的银屑病关节炎症状再次出现.患者改用依库珠单抗和ustekinumab,控制了她的银屑病关节炎和德维奇综合征。
结论:很少有报道确定利妥昔单抗可诱发银屑病关节炎发作,增加了对银屑病症状潜在影响的不确定性。利妥昔单抗加重银屑病关节炎的确切机制仍不确定。该病例报告强调利妥昔单抗可使银屑病和银屑病关节炎恶化,而且Devic综合征的复杂性可能需要调整药物治疗。
BACKGROUND: Devic\'s syndrome is a rare autoimmune disorder that occurs when the body\'s immune system damages and mistakenly attacks the optic nerves and the spinal cord, leading to numerous neurological. Symptoms, such as inflammation, weakness, numbness, and vision problems. Rituximab has mainly been utilized as an immunosuppressive therapy for patients with Devic\'s syndrome. Although evidence has shown that rituximab is efficient and well tolerated in treating patients with Devic\'s syndrome, there is the possibility of rituximab exacerbating severe psoriasis and psoriatic arthritis flare.
METHODS: In this paper, we describe a
case of a 58-year-old female with Devic\'s syndrome, blindness, and neurological involvement who responded exceptionally well to rituximab. However, she developed a severe flare of psoriatic arthritis. After withdrawing from the use of rituximab, her psoriatic arthritis symptoms had resolved. However, she did have another episode of blindness, and rituximab was started once again. Although her vision improved, her psoriatic arthritis symptoms had reoccurred. The patient was switched to eculizumab and ustekinumab, which controlled both her psoriatic arthritis and Devic\'s syndrome.
CONCLUSIONS: Very few
reports have identified rituximab to induce a flare-up of psoriatic arthritis, raising uncertainty regarding its potential effects on psoriatic symptoms. The precise mechanism underlying the exacerbation of psoriatic arthritis by rituximab remains uncertain. This
case report highlights that rituximab can worsen psoriasis and psoriatic arthritis, and that the complexities of Devic\'s syndrome may require medication adjustments.