Nham Tina, Saleh Carol, Chu Derek, Vakaljan Stephanie L, Ohayon Jason A, Siegal Deborah M
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
BMJ Case Rep. 2019 Apr 29;12(4):e228546. doi: 10.1136/bcr-2018-228546.
A 52-year-old man presented with chronic urticaria that was refractory to standard chronic spontaneous urticaria (CSU) treatment. Over time, he developed systemic symptoms including fatigue, weight loss, arthralgia and bone pain. His laboratory investigations also became significant for microcytic anaemia, neutrophilia and elevated C reactive protein, erythrocyte sedimentation rate and IgE levels, in addition to an IgM monoclonal protein. He achieved only partial remission with typical medications for CSU including omalizumab, cyclosporine and cetirizine. After 6 years, his worsening symptoms and abnormal investigations led to a rare diagnosis of Schnitzler's syndrome and a trial of the interleukin 1 receptor antagonist, anakinra, which caused a rapid and complete resolution of his symptoms.
一名52岁男性患有慢性荨麻疹，对标准的慢性自发性荨麻疹（CSU）治疗无效。随着时间的推移，他出现了全身症状，包括疲劳、体重减轻、关节痛和骨痛。他的实验室检查还显示有小细胞贫血、中性粒细胞增多以及C反应蛋白、红细胞沉降率和IgE水平升高，此外还有IgM单克隆蛋白。他使用包括奥马珠单抗、环孢素和西替利嗪在内的CSU典型药物仅获得部分缓解。6年后，他不断恶化的症状和异常检查结果导致了罕见的施尼茨勒综合征诊断，并试用了白细胞介素1受体拮抗剂阿那白滞素，该药物使他的症状迅速完全缓解。
