Graham Kay Frances, McEntegart Anne
Rheumatology, Glasgow Royal Infirmary, Glasgow, UK.
BMJ Case Rep. 2018 Apr 21;2018:bcr-2018-224764. doi: 10.1136/bcr-2018-224764.
We present a case of a 57-year-old woman who contracted pneumonia while on Benepali, the biosimilar version of etanercept for rheumatoid arthritis. She had seropositive erosive disease. She was admitted to clinic with a 2-week history of dyspnoea, dry cough and fever. Her initial examination showed her to be hypoxic on air with saturations of 77% and left basal crackles. Her admission chest X-ray showed fine reticular shadowing, with an initial suspicion of pulmonary fibrosis. She was empirically treated for community-acquired pneumonia but continued to deteriorate with a worsening type 1 respiratory failure. She was intubated and ventilated on intensive care. The suspicion was raised of pneumonia given her immunosuppression, hypoxic presentation and chest X-ray changes. This was confirmed on sputum PCR. She was treated with a 3-week course of steroids and co-trimoxazole. She was discharged home after a 2-week admission.
我们报告一例57岁女性病例，该患者在使用类风湿关节炎生物仿制药贝纳利（依那西普的生物仿制药）期间感染了肺炎。她患有血清阳性侵蚀性疾病。她因呼吸困难、干咳和发热2周病史入院。初次检查显示她在空气中缺氧，血氧饱和度为77%，左肺底部有湿啰音。入院时胸部X线显示有细微网状阴影，初步怀疑为肺纤维化。她接受了社区获得性肺炎的经验性治疗，但病情继续恶化，出现了更严重的Ⅰ型呼吸衰竭。她在重症监护室接受了插管和通气治疗。鉴于她的免疫抑制、缺氧表现和胸部X线改变，怀疑是肺炎。痰PCR证实了这一诊断。她接受了为期3周的类固醇和复方新诺明治疗。入院2周后出院回家。
