Diagnostic approaches and treatments of systemic sclerosis patient with interstitial lung disease

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Fauziah Diayu Retnaningtyas, Awalia
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Abstract

Background: Systemic sclerosis or scleroderma is a rare disease with multiple complications which may include interstitial lung disease. The findings of diffuse type of systemic sclerosis, moderate restriction in pulmonary function test, interstitial pneumonia in chest x-ray, and ground glass opacity in thoracic CT-scan establish the diagnosis of interstitial lung disease associated with systemic sclerosis. We present a case of interstitial lung disease in a systemic sclerosis case, which was approached and treated comprehensively to slow the progression. Case Presentation: A 40-year-old female was admitted to the rheumatology polyclinic of Dr. Soetomo Hospital Surabaya with persistent dry cough for two years in June 2021. The patient also complained of breathlessness, painful joints, swollen knees, and morning stiffness three months prior to admission. The positive results of antinuclear antibody and rheumatoid factor were identified in 2016, which suggested autoimmune disease of scleroderma and being treated with azathioprine 50 mg twice a day, methylprednisolone 4 mg once a day, chloroquine 200 mg once a day, and calcium lactate once a day. The examinations in 2020 showed moderate restriction from the pulmonary function test, bilateral lung parenchymal infiltrates from the chest x-ray, and ground-glass opacity from the chest computed tomography scan (CT-scan). The patient was monthly prescribed cyclophosphamide 500 mg intravenously for six months as the substitution of azathioprine, methylprednisolone 4 mg once a day, and aspirin 100 mg once a day. The latest worsening condition led the patient to receive the substitution of cyclophosphamide which was mycophenolate mofetil 360 mg twice a day, along with aspirin 100mg and methylprednisolone 4 mg once a day, respectively. Conclusion: As a rare disease, the complications of systemic sclerosis should be anticipated. In this case, interstitial lung disease occurred following nearly five years of systemic sclerosis course which required immunosuppressive agents to enhance the efficacy of treatment. Comprehensive treatment with tight monitoring is necessary to slow the disease progression.
伴有间质性肺病的系统性硬化症患者的诊断方法和治疗方法
背景:系统性硬化症或硬皮病是一种罕见疾病,具有多种并发症,其中可能包括间质性肺病。弥漫型系统性硬化症、肺功能测试中度受限、胸部 X 光片显示间质性肺炎、胸部 CT 扫描显示磨玻璃不透明,这些发现可确诊为与系统性硬化症相关的间质性肺病。我们将介绍一例系统性硬化症患者的间质性肺病病例,该病例经过综合治疗,延缓了病情的发展:一名 40 岁的女性因持续干咳两年于 2021 年 6 月入住泗水 Soetomo 医生医院风湿病综合门诊。入院前三个月,患者还主诉呼吸困难、关节疼痛、膝盖肿胀和晨僵。2016年发现抗核抗体和类风湿因子阳性,提示患有硬皮病自身免疫性疾病,并接受硫唑嘌呤50毫克,每天两次,甲泼尼龙4毫克,每天一次,氯喹200毫克,每天一次,乳酸钙每天一次的治疗。2020 年的检查显示,肺功能检查结果为中度受限,胸部 X 光检查结果为双侧肺实质浸润,胸部计算机断层扫描(CT 扫描)结果为磨玻璃不透明。作为硫唑嘌呤、甲基强的松龙(4 毫克,每天一次)和阿司匹林(100 毫克,每天一次)的替代药物,患者每月被处方静脉注射环磷酰胺 500 毫克,为期 6 个月。最近病情恶化,患者又接受了环磷酰胺的替代治疗,即霉酚酸酯 360 毫克,每天两次,同时分别服用阿司匹林 100 毫克和甲泼尼龙 4 毫克,每天一次:结论:作为一种罕见疾病,系统性硬化症的并发症是可以预见的。本病例在系统性硬化病程近五年后出现间质性肺病,需要使用免疫抑制剂来提高疗效。有必要在严格监测的情况下进行综合治疗,以延缓疾病的进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Bali Medical Journal
Bali Medical Journal MEDICINE, GENERAL & INTERNAL-
自引率
50.00%
发文量
8
审稿时长
3 weeks
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