Division of Rheumatology, Department of Medicine, UF Health Jacksonville, Jacksonville, Florida, USA
Division of Rheumatology, Department of Medicine, UF Health Jacksonville, Jacksonville, Florida, USA.
BMJ Case Rep. 2021 Apr 12;14(4):e241125. doi: 10.1136/bcr-2020-241125.
We describe a case of a 48-year-old woman who presented with acute respiratory failure due to diffuse alveolar haemorrhage and acute renal failure due to pauci-immune glomerulonephritis consistent with a new diagnosis of microscopic polyangiitis (MPA). The patient had a recent SARS-CoV-2 infection 6 weeks before MPA diagnosis and had stopped immunosuppression for her rheumatoid arthritis (RA) at that time. The patient was treated with pulse intravenous steroids, plasma exchange therapy and rituximab, which induced remission of her illness. This case highlights a timely dilemma of holding immunosuppression in a RA patient with low disease activity on combination therapy with SARS-CoV-2 infection, and the potential risk of developing an additional autoimmune disease, such as vasculitis, given their existing autoimmunity due to RA.
我们描述了一例 48 岁女性患者，因弥漫性肺泡出血导致急性呼吸衰竭，因少免疫性肾小球肾炎导致急性肾衰竭，符合显微镜下多血管炎（MPA）的新诊断。患者在 MPA 诊断前 6 周有最近的 SARS-CoV-2 感染，并在当时停止了类风湿关节炎（RA）的免疫抑制治疗。该患者接受了脉冲静脉内类固醇、血浆置换疗法和利妥昔单抗治疗，诱导疾病缓解。本病例突出了在 SARS-CoV-2 感染合并低疾病活动的 RA 患者中维持免疫抑制治疗的时机难题，以及由于 RA 导致的现有自身免疫性疾病，如血管炎，发生额外自身免疫性疾病的潜在风险。
