A case of eosinophilic granulomatosis with polyangiitis after prolonged intervals of an anti-interleukin-6 receptor antibody for rheumatoid arthritis
A case of eosinophilic granulomatosis with polyangiitis after prolonged intervals of an anti-interleukin-6 receptor antibody for rheumatoid arthritis
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长期使用治疗类风湿性关节炎的抗白细胞介素 6 受体抗体后出现嗜酸性肉芽肿性多血管炎一例
DOI：
10.1093/mrcr/rxab010
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发表时间：
2021
影响因子：
0.8
通讯作者：
Takeuchi Tsutomu
中科院分区：
文献类型：
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作者：
Imai Yuki;Kondo Yasushi;Ishigaki Sho;Nishina Naoshi;Ota Yuichiro;Hanaoka Hironari;Kaneko Yuko;Takeuchi Tsutomu
一位83岁有哮喘史的女性主诉左腹痛，住进了我们医院。她接受了tocilizumab治疗，这是一种抗白细胞介素6受体抗体，治疗类风湿性关节炎(RA)的间隔时间较长。实验室检查显示，抗中性粒细胞胞浆抗体阴性的患者嗜酸性粒细胞计数和炎症标志物显著增加。超声心动图显示心包积液，对比增强计算机断层扫描显示胃窦壁增厚。上消化道内窥镜和活检显示胃黏膜上皮内有嗜酸性粒细胞浸润。她被诊断为嗜酸性肉芽肿伴多血管炎(EGPA)，并伴有心包炎和嗜酸性胃肠炎。大剂量糖皮质激素和间歇性静脉注射环磷酰胺(IVCY)开始，导致缓解。由于IL-6参与了过敏性疾病如哮喘的发病机制，我们的病例可以提供关于IL-6在EGPA中的致病作用的见解，因为在我们的病例中，EGPA的发生可能是由随着tocilizumab间期延长而增强的IL-6信号所触发的。
An 83-year-old woman with a history of asthma complained of left abdominal pain and was admitted to our hospital. She was treated with tocilizumab, an anti-interleukin (IL)-6 receptor antibody, with a prolonged interval for rheumatoid arthritis (RA). Laboratory tests revealed a remarkable increase in eosinophil count and inflammatory markers with negative antineutrophil cytoplasmic antibodies. Echocardiography revealed pericardial fluid retention, and contrast-enhanced computed tomography revealed the thickening of the gastric antrum wall. Upper gastrointestinal endoscopy and biopsy revealed eosinophilic infiltration into the gastric mucosal epithelium. She was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) with pericarditis and eosinophilic gastroenteritis. High-dose glucocorticoids with intermittent intravenous cyclophosphamide (IVCY) were initiated, resulting in remission. As IL-6 is involved in the pathogenesis of allergic diseases such as asthma, our case can provide insights into the pathogenic role of IL-6 in EGPA as the development of EGPA in our case may have been triggered by IL-6 signals enhanced with tocilizumab interval prolongation.