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COVID-19 与成人斯蒂尔病同为高铁蛋白血症综合征的一部分。

COVID-19 and adult-onset Still's disease as part of hyperferritinemic syndromes.

机构信息

Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

出版信息

Mod Rheumatol Case Rep. 2022 Jan 7;6(1):101-105. doi: 10.1093/mrcr/rxab032.

Abstract

The coronavirus disease (COVID-19) is known to cause hyperferritinemia and haemophagocytic lymphohistiocytosis. Including this laboratory parameter, symptoms similar to COVID-19 have been observed in adult-onset Still's disease (AOSD), catastrophic antiphospholipid syndrome, macrophage activation syndrome, and septic shock, which has led to the proposal of a concept called 'hyperferritinemic syndromes'. High levels of some clinical markers in both COVID-19 and AOSD make them difficult to differentiate. While the efficacy of ciclesonide had been expected for mild pneumonia with COVID-19, the efficacy of tocilizumab (TCZ), which is a known treatment for AOSD, was not established. We report the first known occurrence of COVID-19 diagnosed in March 2020, preceded by the diagnosis of AOSD in April 2019. The patient was given prednisolone and TCZ, which led to remission. With the dyspnea and ground-glass appearance on chest computed tomography, PCR test revealed COVID-19 infection. Ciclesonide was started on Day 7 of the disease onset, which led to improved inflammatory markers. We infer that while TCZ is theoretically useful for COVID-19 due to its inhibition of interleukin 6. AOSD and COVID-19 may be differentiated by levels of ferritin, and appropriate treatment must be allocated.

摘要

已知冠状病毒病 (COVID-19) 可引起血铁蛋白过多症和噬血细胞性淋巴组织细胞增多症。在成人Still 病 (AOSD)、灾难性抗磷脂综合征、巨噬细胞活化综合征和感染性休克中观察到与 COVID-19 相似的症状,包括这种实验室参数,这导致了提出了一个称为“高血铁蛋白血症综合征”的概念。COVID-19 和 AOSD 中一些临床标志物的高水平使得它们难以区分。虽然预计 ciclesonide 对 COVID-19 轻度肺炎有效,但作为 AOSD 已知治疗方法的 tocilizumab (TCZ) 的疗效尚未确定。我们报告了首例已知的 COVID-19 病例,该病例于 2020 年 3 月确诊,之前于 2019 年 4 月确诊为 AOSD。患者接受了泼尼松龙和 TCZ 治疗,病情缓解。由于呼吸困难和胸部 CT 磨玻璃样改变,PCR 检测显示 COVID-19 感染。在疾病发病第 7 天开始使用 ciclesonide,导致炎症标志物改善。我们推断,虽然 TCZ 由于其抑制白细胞介素 6 而在理论上对 COVID-19 有用。AOSD 和 COVID-19 可以通过铁蛋白水平来区分,必须分配适当的治疗。

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