Chayama Ryoka, Amano Shiho, Ofuji Satoshi, Sano Chiaki, Ohta Ryuichi
Family Medicine, Shimane Prefectural Central Hospital, Izumo, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2023 Dec 10;15(12):e50278. doi: 10.7759/cureus.50278. eCollection 2023 Dec.
The coexistence of autoimmune diseases presents a significant diagnostic challenge in clinical practice, particularly in settings with limited resources. This case report details a rare instance of pustular psoriasis occurring concurrently with rheumatoid arthritis, underscoring the complexities involved in diagnosing overlapping autoimmune disorders. A 70-year-old male with a history of chronic heart failure, atrial fibrillation, and other comorbidities presented to a rural community hospital with a year-long persistent rash and joint and back pain. Physical examination and blood tests revealed high inflammatory markers. A dermatological assessment, including a skin biopsy, diagnosed generalized pustular psoriasis. However, the atypical presentation of acute polyarthritis led to further investigations, revealing elevated rheumatoid factor and anti-citrullinated protein antibody levels, resulting in a diagnosis of late-onset rheumatoid arthritis. The patient underwent a comprehensive treatment regime, including prednisolone, cefazolin, oral terbinafine, methotrexate, and infliximab, leading to gradual symptom improvement to the previous activity of daily life and discharge on the 27th day of hospitalization. This case illustrates the diagnostic intricacies in identifying concurrent autoimmune disorders and highlights the crucial role of general physicians in systematically approaching complex cases in resource-limited settings. It emphasizes the need for heightened clinical vigilance and a multifaceted diagnostic approach when managing patients with overlapping rheumatic symptoms, advocating for consideration of coexisting conditions in autoimmune diseases.
自身免疫性疾病的共存给临床实践带来了重大的诊断挑战，在资源有限的环境中尤其如此。本病例报告详细介绍了一例脓疱型银屑病与类风湿性关节炎同时发生的罕见病例，强调了诊断重叠自身免疫性疾病所涉及的复杂性。一名70岁男性，有慢性心力衰竭、心房颤动和其他合并症病史，因持续一年的皮疹、关节和背部疼痛就诊于一家农村社区医院。体格检查和血液检查显示炎症标志物升高。包括皮肤活检在内的皮肤科评估诊断为泛发性脓疱型银屑病。然而，急性多关节炎的非典型表现促使进一步检查，结果显示类风湿因子和抗瓜氨酸化蛋白抗体水平升高，最终诊断为迟发性类风湿性关节炎。患者接受了包括泼尼松龙、头孢唑林、口服特比萘芬、甲氨蝶呤和英夫利昔单抗在内的综合治疗方案，症状逐渐改善至先前的日常生活活动水平，并于住院第27天出院。该病例说明了识别并发自身免疫性疾病时的诊断复杂性，并强调了全科医生在资源有限的环境中系统处理复杂病例的关键作用。它强调在管理有重叠风湿症状的患者时需要提高临床警惕性并采取多方面的诊断方法，主张考虑自身免疫性疾病中的共存情况。
