A Surgical Case of Acute Aortic Dissection in a Patient with Rheumatoid Arthritis Being Treated with Tacrolimus / 日本心臓血管外科学会雑誌

ABSTRACT

We report a rare case of acute type A aortic dissection in a patient with rheumatoid arthritis (RA) being treated with tacrolimus. The patient was a 77-year-old woman, who had received implantation of 6 artificial joints and was treated with 3 mg/day of tacrolimus and 10 mg/day of prednisolone. Tacrolimus, one of the immunosuppressive drugs for severe RA, had been applied to her to reduce the amount of prednisolone. An emergency surgery was performed successfully and 20 mg/day of prednisolone was administered for RA instead of her preoperative regimen. Such simplification of RA medication was actually useful to us for managing her difficult postoperative care. Respiratory insufficiency with persistent preural effusion was regulated by non-invasive positive pressure ventilation (NPPV) and pleural drainage. Disuse syndrome was treated with enteral nutrition and rehabilitation. Such care was also useful for her recovery.