RESUMO
CASE PRESENTATION: A 78-year-old man with asthma and COPD presented with shortness of breath, cough, and severe malaise for 4 days. Upon arrival, the patient was conscious and body temperature was 37.5°C. Arterial oxygen saturation (Spo2) was 80% on room air. Laboratory data demonstrated a WBC count of 17,400/µL (89.5% neutrophils) and C-reactive protein of 5.00 mg/dL. CT scan of chest revealed scattered ground-glass in the upper right lobe and thickening of the bronchial wall. Based on these findings, acute bronchopneumonia was diagnosed and antibacterial therapy was started. The day after admission, the patient's general condition and shortness of breath had gradually improved. We treated and observed him carefully for 10 days in the hospital on antibacterial therapy because of his underlying comorbidities (asthma and COPD) and his ongoing hypoxemia. Three days after discharge, the patient re-presented with shortness of breath, hypoxemia, and loss of appetite. The patient was hospitalized for a second time.
Assuntos
Alveolite Alérgica Extrínseca/diagnóstico , Idoso , Alveolite Alérgica Extrínseca/sangue , Alveolite Alérgica Extrínseca/tratamento farmacológico , Líquido da Lavagem Broncoalveolar , Diagnóstico Diferencial , Dispneia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Neutrófilos , Prednisolona/uso terapêuticoAssuntos
Autoanticorpos/imunologia , Síndrome de Behçet/imunologia , Claudina-1/imunologia , Junções Íntimas/imunologia , Adulto , Idoso , Artrite Reumatoide/sangue , Artrite Reumatoide/imunologia , Autoanticorpos/sangue , Síndrome de Behçet/sangue , Biomarcadores/sangue , Claudina-1/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Serial de ProteínasRESUMO
Ankylosing spondylitis (AS) is a chronic inflammatory osteoarticular disease. Although the etiology remains unknown, proinflammatory cytokines, such as tumor necrosis factor α and interleukin-6, have been implicated in the development of AS. Here, we report that a patient with AS, whose disease had been refractory to conventional treatment regimens and who needed to receive continuous corticosteroid, responded well to tocilizumab. While further clinical evaluation is required, tocilizumab may be an optional treatment for AS.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Receptores de Interleucina-6/imunologia , Espondilite Anquilosante/tratamento farmacológico , Adulto , Proteína C-Reativa/metabolismo , Antígeno HLA-B27/sangue , Humanos , Imageamento por Ressonância Magnética , Masculino , Índice de Gravidade de Doença , Espondilite Anquilosante/sangue , Espondilite Anquilosante/diagnósticoRESUMO
A 65-year-old woman who had suffered from chronic graft-versus-host disease (GVHD) presented with extensive purpura and was diagnosed with acquired hemophilia A. Because she was refractory to corticosteroids and her condition was complicated with diabetes mellitus, glaucoma, and hypoglobulinemia, she was treated with tocilizumab. Tocilizumab treatment increased the activity of factor VIII in a rapid and sustained manner, leading to a reduction of the prednisolone dose. Tocilizumab may thus be an optional treatment modality for acquired hemophilia A.