Elhadari Sara, Hamad Mahir
Acute Medicine Department, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
Open Access Rheumatol. 2020 Jul 14;12:127-131. doi: 10.2147/OARRR.S259746. eCollection 2020.
A 67-year-old Caucasian female presented in August 2019 to our rheumatology service, with 3 days history of severe neck pain and right-sided headache with aches in both shoulders and arms and mild stiffness. Other symptoms included mild jaw claudication. She had recently returned from Majorca after an uneventful two-week trip. She had a background of severe allergic asthma and allergic rhinitis, well controlled with omalizumab which was started in 2016, based on persistently high IgE. Her sister suffers from a type of vasculitis and is currently on steroids. The patient is an ex-smoker and drinks two bottles of wine a week. She had high inflammatory markers with raised eosinophilic count and was admitted for further work up to rule out infection and to commence steroid after for a likely diagnosis of eosinophilic granulomatosis with polyangiitis. Shortly after admission to the acute assessment unit, she became confused and febrile. An extensive work up ruled out infection, and she was started on steroids and treated for acute hyponatremia. Omalizumab was stopped. She improved and was discharged on a tapering dose of steroids and was weaned off completely within 4 months. Her inflammatory markers returned to normal as well as her eosinophilic count, with complete resolution of her presenting symptoms.
一名67岁的白种女性于2019年8月前来我们的风湿病科就诊，有3天严重颈部疼痛和右侧头痛病史，双肩和双臂疼痛，并有轻度僵硬感。其他症状包括轻度颌部间歇性运动障碍。她最近在马略卡岛度过了为期两周的平安旅行后返回。她有严重过敏性哮喘和过敏性鼻炎病史，基于持续高IgE水平，自2016年开始使用奥马珠单抗进行良好控制。她的姐姐患有某种血管炎，目前正在使用类固醇治疗。该患者已戒烟，每周饮用两瓶葡萄酒。她的炎症指标升高，嗜酸性粒细胞计数增加，因可能诊断为嗜酸性肉芽肿性多血管炎而入院进一步检查以排除感染并开始使用类固醇治疗。在入住急性评估病房后不久，她出现意识模糊和发热。全面检查排除了感染，开始给予她类固醇治疗并治疗急性低钠血症。停用了奥马珠单抗。她病情好转，出院时逐渐减少类固醇剂量，并在4个月内完全停用。她的炎症指标和嗜酸性粒细胞计数恢复正常，出现的症状完全缓解。
