Costa Rita, Antunes Paula, Salvador Pedro, Oliveira Pedro, Marinho António
Internal Medicine Department, Centro Hospitalar Vila Nova De Gaia, Vila Nova de Gaia, PRT.
Internal Medicine, Hospital de Cascais Dr José de Almeida, Lisboa, PRT.
Cureus. 2021 Aug 15;13(8):e17198. doi: 10.7759/cureus.17198. eCollection 2021 Aug.
Lupus nephritis (LN) is the most frequent severe organ manifestation of systemic lupus erythematosus (SLE). About 30% of patients are refractory to treatment. The authors report a case of treatment of LN with interleukin-17-targeted therapy, demonstrating its possible benefit, after reports of T helper 17 cell involvement in SLE pathogenesis. We present the case of a childbearing age woman with SLE, who developed refractory LN despite all the indicated therapeutic options. During follow up, infection with human papillomavirus was detected, a possible trigger, and the following management was based on this discovery. We currently know that cytokines play a major role in tissue damage and interleukin-17 (IL-17) seems to be a fundamental key in SLE and LN, having shown its expression in renal glomeruli and urinary sediment. Thus, it was decided to start treatment with an anti-IL-17A antibody, secukinumab. After starting secukinumab, clinical and biological features improved and complete renal response was achieved.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）最常见的严重器官表现。约30%的患者治疗无效。在有报道称辅助性T细胞17参与SLE发病机制后，作者报告了1例采用白细胞介素-17靶向治疗LN的病例，证明了其可能的益处。我们介绍1例育龄期SLE女性病例，尽管采用了所有指定的治疗方案，但仍发生了难治性LN。在随访期间，检测到感染人乳头瘤病毒，这可能是一个触发因素，后续治疗基于这一发现。我们目前知道细胞因子在组织损伤中起主要作用，白细胞介素-17（IL-17）似乎是SLE和LN的一个关键因素，已在肾小球和尿沉渣中显示出其表达。因此，决定开始使用抗IL-17A抗体司库奇尤单抗进行治疗。开始使用司库奇尤单抗后，临床和生物学特征得到改善，并实现了完全肾脏缓解。
