Connective Tissue Disease Following Hepatitis B Vaccination
Connective Tissue Disease Following Hepatitis B Vaccination
复制标题
DOI：
10.1097/rhu.0b013e31829d558a
复制
发表时间：
2013-08-01
影响因子：
3.4
通讯作者：
Hassan, Cesare
中科院分区：
文献类型：
--
作者：
Bruzzese, Vincenzo;Zullo, Angelo;Hassan, Cesare
我们已经提出了一个复杂的情况下，结缔组织病出现后不久，乙肝疫苗接种。该病例被适当地诊断为UCTD，因为症状不符合当时诊断系统性红斑狼疮（SLE）所需的1997年美国流变学学会（ACR）标准。9虽然我们的病人表现出的一些症状，即脱发、神经病变和乏力，与SLE相符，但它们不符合1997年ACR SLE分类标准。9事实上，只有关节炎和抗核抗体阳性属于ACR SLE分类标准。另一方面，如果我们根据最近修订的ACR（仅在我们的病例诊断后可用）对我们的患者进行回顾性重新分类，10接种后症状将符合SLE诊断所需的标准，因为无瘢痕性脱发和神经病变已被升级为SLE特异性标准。10这并不出乎意料，因为新的标准在验证过程中显示出更敏感，但不那么具体。由于在18个月的随访中没有出现新的SLE症状/体征，因此UCTD与SLE之间仍存在一些不确定性。
DISCUSSIONWe have presented a complex case of connective tissue disease that appeared a short time after HBV vaccination. Such case was appropriately diagnosed as UCTD, because the symptoms failed to satisfy the 1997 American College of Rheumatology (ACR) criteria required for the diagnosis of systemic lupus erythematosus (SLE) at that time. 9 Although some symptoms presented by our patient—that is, alopecia, neuropathy, and asthenia—were compatible with SLE, they failed to fulfill the 1997 ACR SLE-classifying criteria. 9 Indeed, only arthritis and antinuclear antibody positivity were among the ACR SLE-classifying criteria. On the other hand, if we retrospectively reclassify our patient according to a recent revision of the ACR that was available only after our case diagnosis, 10 the postvaccination symptoms would fulfill the criteria required for SLE diagnosis, because nonscarring alopecia and neuropathy have been upgraded as SLE-specific criteria. 10 This was not unexpected, because the new criteria have been shown to be more sensitive, but less specific, in the validation process. Because no new SLE symptom/sign appeared in the 18 months of follow-up, some uncertainty between UCTD and SLE remains.