Osman Afaf, Galiatsatos Panagis, Bose Sonali, Danoff Sonye
Department of Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Department of Critical Care Medical, National Institutes of Health, Bethesda, Maryland, USA.
BMJ Case Rep. 2017 Jun 14;2017:bcr-2017-220509. doi: 10.1136/bcr-2017-220509.
Pulmonary vascular involvement due to rheumatoid arthritis, presenting as diffuse alveolar haemorrhage (DAH), is a rare phenomenon, especially if there are no signs of systemic vasculitides. Furthermore, how to proceed with the management of these patients is challenging, as in the case of our patient, who had recurrent DAH. We present a case of a patient with known rheumatoid arthritis who had recurrence of DAH that spanned over several years, often presenting with life-threatening respiratory failure. While her DAH presentation improved with high-dose glucocorticoids, to resolve her recurrence, we opted to initiate treatment with rituximab, with a short course of azathioprine. After the second round of rituximab, the patient continues to do well without any further DAH-related complications. We also summarise prior cases of such patients to highlight variable treatment options.
类风湿关节炎所致的肺血管受累表现为弥漫性肺泡出血（DAH），是一种罕见现象，尤其是在没有系统性血管炎体征的情况下。此外，如何对这些患者进行管理具有挑战性，就像我们这位患有复发性DAH的患者一样。我们报告一例已知患有类风湿关节炎的患者，其DAH复发持续数年，常出现危及生命的呼吸衰竭。虽然她的DAH表现通过大剂量糖皮质激素得到改善，但为了解决其复发问题，我们选择使用利妥昔单抗并短期联用硫唑嘌呤进行治疗。在第二轮利妥昔单抗治疗后，患者情况良好，未出现任何与DAH相关的进一步并发症。我们还总结了此类患者之前的病例，以突出不同的治疗选择。
