Modern rheumatology case reports最新文献

{"title":"A case of newly onset rheumatoid arthritis successfully treated with methotrexate under the anti-retrovirus therapy against HIV infection.","authors":"Ippei Miyagawa, Shingo Nakayamada, Kazuyoshi Saito, Shoichi Shimizu, Kentaro Hanami, Masanobu Ueno, Yoshiya Tanaka","doi":"10.1093/mrcr/rxaf011","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf011","url":null,"abstract":"<p><p>The patient was a 70-year-old woman. In July 2018, she developed pneumocystis pneumonia and was diagnosed with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Antiretroviral therapy (ART) was continued, the HIV-RNA load was suppressed, and the CD4+cells count was maintained. In 2024, the polyarticular pain and swelling persisted. HIV-associated arthropathy, reactive arthritis, and other diseases were excluded. The patient was diagnosed with rheumatoid arthritis (RA) according to the ACR/EULAR 2010 Rheumatoid Arthritis Classification Criteria. Joint radiography revealed narrowing of the wrist joint, and joint ultrasonography showed synovial thickening and power doppler signals, supporting the diagnosis of RA. Methotrexate was initiated, and remission was achieved and maintained. After starting MTX, HIV-RNA load increased transiently but rapidly decreased after that. CD4+cells count was maintained. Patients with HIV have underlying immune dysfunction, and RA requires treatment with immunosuppressants (DMARDs), which makes treatment challenging. Recently, HIV infection has been considered a factor that makes the diagnosis of RA difficult. When symptoms suggestive of RA are observed in HIV-infected patients, it is important to make a thorough differential diagnosis and determine a treatment plan based on the characteristics of RA complicated by HIV infection.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Granulomatosis with Polyangiitis Initially Presenting as Frequent Urination Mimicking a Prostatic Abscess: A Case Report.","authors":"Riko Kamada, Makoto Hibino, Hikari Higa, Shigehiro Watanabe, Kazunari Maeda, Syunichi Tobe, Takuya Kakutani, Tetsuri Kondo","doi":"10.1093/mrcr/rxaf010","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf010","url":null,"abstract":"<p><p>Granulomatosis with polyangiitis (GPA) rarely involves the urological system. Herein, we report the case of a 71-year-old man with GPA who presented with frequent urination and a computed tomography detected low-density area in the enlarged prostate, suggesting an abscess. The initial prostate biopsy revealed necrotic tissue consistent with a prostate abscess, with severe destruction ultimately leading to a bladder fistula. However, upon further review of the pathology samples, multinucleated giant cells were identified, raising suspicion for GPA. Further history revealed bloody nasal discharge, and biopsy results from a lung mass also indicated GPA. Based on these findings-along with sinusitis and PR3-ANCA positivity-the diagnosis of GPA was made. Our patient was treated with steroid pulse therapy; however, disease progression could not be controlled, and he died suddenly due to haemorrhagic cerebral infarction. Autopsy revealed granulomas in the lungs and spleen, crescentic glomerulonephritis in the kidneys, and haemorrhagic infarction with an embolized fibrin clot in the brain. Urogenital lesions in GPA can be challenging to diagnose due to their nonspecific presentation, and clinicians should consider GPA in patients presenting with unexplained prostatitis and systemic symptoms, as early diagnosis and treatment could prevent unnecessary surgeries and improve prognosis.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Neuropathy in Systemic Sclerosis with Proximal Nerve Involvement: Diagnostic Challenges and Response to Corticosteroid Therapy.","authors":"Takehiro Suzuki, Takahiro Kawasaki, Goichi Beck, Noyuri Takenaka, Kotaro Ogawa, Eri Itotagawa, Kazuki Matsukawa, Michiko Ohashi, Takeshi Kaneko, Eri Oguro-Igashira, Yumiko Mizuno, Mayuko Izumi, Kohei Tsujimoto, Yasutaka Okita, Takayoshi Morita, Akane Watanabe, Yasuhiro Kato, Masayuki Nishide, Sumiyuki Nishida, Yoshihito Shima, Masashi Narazaki, Atsushi Kumanogoh","doi":"10.1093/mrcr/rxaf005","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf005","url":null,"abstract":"<p><p>Peripheral neuropathy is a complication in systemic sclerosis that is occasionally encountered in clinical settings. The mechanisms underlying this condition remain unclear and treatment strategies have not yet been established, making management challenging. Here, we report a case of peripheral neuropathy associated with systemic sclerosis that was successfully treated with corticosteroid therapy despite the absence of conventional inflammatory findings on histopathology or blood tests. A 44-year-old Japanese man diagnosed with systemic sclerosis presented with gradually worsening paresthesia and gait disorder. A nerve conduction study and histological examination of a biopsy sample from the left sural nerve, where the nerve conduction study indicated abnormalities, revealed findings consistent with peripheral neuropathy associated with systemic sclerosis. The results of blood tests or cerebrospinal fluid analysis did not indicate significant inflammatory findings, aside from a slight elevation in protein levels in the cerebrospinal fluid. Similarly, the histological analysis of the nerve biopsy showed no signs of inflammation. T2-weighted magnetic resonance imaging of the lumbar region revealed hyperintensity at the nerve roots, suggesting inflammation at the nerve roots. Based on these findings, we initiated corticosteroid therapy, which led to an improvement in both the patient's symptoms and results in the nerve conduction study. This case provides new insights into the pathogenesis of peripheral neuropathy associated with systemic sclerosis and highlights that the potential benefits of immunosuppressive therapy should not be overlooked, even in the absence of conventional inflammatory signs.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful switching treatment of mepolizumab for refractory eosinophilic granulomatosis with polyangiitis and multiple organ dysfunction under benralizumab treatment: A case report.","authors":"Toshitaka Yukishima, Haruka Yonezawa, Yuya Aono, Kazuyuki Yamaguchi, Yoshiro Otsuki, Shin-Ichiro Ohmura","doi":"10.1093/mrcr/rxaf008","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf008","url":null,"abstract":"<p><p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare necrotising vasculitis affecting small vessels accompanied by eosinophilic inflammation. Biological therapies, particularly anti-interleukin-5 (IL-5) monoclonal antibodies, have been shown to be effective in treating refractory EGPA. Mepolizumab, an anti-IL-5 monoclonal antibody, has been approved in Japan for the treatment of EGPA and has a significant glucocorticoid-sparing effect. Benralizumab, an anti-IL-5 receptor monoclonal antibody, has also been reported to reduce the glucocorticoid dose in patients with EGPA. However, several investigators have reported the development of EGPA during biologic treatment. Herein, we present a case of development of refractory EGPA under benralizumab treatment. Although the initial treatment with high-dose glucocorticoids and the administration of benralizumab were temporally effective, the patient's condition did not improve, and the eosinophil count reelevated. After switching benralizumab to mepolizumab, the patient's condition improved, and remission was achieved. Our report suggested that mepolizumab may be an effective treatment option for refractory EGPA after failure of benralizumab treatment.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of high tibial osteotomy in a patient with psoriatic arthritis.","authors":"Mikiro Koga, Akira Maeyama, Tetsuro Ishimatsu, Tomonobu Hagio, Terufumi Shibata, Yutaro Yamasaki, Yuki Sugino, Takuaki Yamamoto","doi":"10.1093/mrcr/rxaf007","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf007","url":null,"abstract":"<p><p>Traditionally, patients with rheumatic diseases, such as rheumatoid arthritis (RA), were considered off-limits for joint-sparing surgery. In the present study, we report bilateral knee joints of psoriatic arthritis coexisting with osteoarthritis, with good, albeit short-term, results. 62-year-old woman was treated for psoriatic arthritis with a biologic (adalimumab). The Disease Activity in Psoriatic Arthritis index was 7.24, indicating low disease activity. She had been suffering from bilateral knee pain for some time and was treated conservatively by her local doctor, but the pain persisted, and she came to visit us. At the initial visit, tenderness in the medial joint line of both knees and hydrarthrosis in the right knee were observed. Radiographs at the time of the initial examination showed medial type osteoarthritis (Kellgren-Lawrence classification IV) in both knees. First, interlocking closed wedge high tibial osteotomy (CWHTO) was performed on the right knee. This was followed 1 year later by right knee implant removal and interlocking CWHTO on the left knee, and implant removal on the left knee 1 year after that. The joint range of motion improved in both knees preoperatively and postoperatively, and the change in the Knee Injury and Osteoarthritis Outcome Score total from preoperative to 1 year postoperatively was from 26.0 to 59.4 points for the right knee and from 48.6 points to 70.5 points for the left knee, with improvement in both knees. Considering the patient's background, we considered high tibial osteotomy if the disease activity was controlled. However, if the disease worsens in the future, joint destruction may occur, so careful follow-up is necessary.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse Alveolar Hemorrhage as the initial Presentation of Systemic Lupus Erythematous Possibly Triggered by Rhogam Injection in a 24-year-old Pregnant Woman; a case report.","authors":"Amir Khanmirzaei, Maryam Bozorgi, Gelareh Azarinoush, Fatemeh Aghaei, Asiye Bigdeli, Kimia Jazi, Akram Asghari, Maryam Masoumi","doi":"10.1093/mrcr/rxaf001","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf001","url":null,"abstract":"<p><p>Diffuse Alveolar Hemorrhage (DAH) is an uncommon and potentially life-threatening occurrence in systemic lupus erythematous (SLE), involving bleeding into the alveolar space caused by the disruption of the alveolar-capillary basement membrane. We present a 24-year-old Persian woman with a complaint of progressively worsening shortness of breath following the administration of intramuscular-Rhogam after 3 days. According to her worsening clinical condition, the pregnancy was terminated. She was admitted to intensive care unit and intubated. Simultaneously, she developed fungal and bacterial pneumonia tolerant to therapies. After several investigations, the patient was finally diagnosed with SLE along with diffuse alveolar hemorrhage, as the first presentation of the disease. This is the first case of a pregnant woman experiencing diffuse alveolar hemorrhage as a Lupus flare following Rhogam injection. Clinicians should be aware of the mimicry nature of lupus, and the importance of immune reactions in these patients.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Young Onset Chronic Inflammatory Back Pain: A Diagnostic Dilemma Between Axial Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis.","authors":"Rajaie Namas, Sarah Al Qassimi, Jawahir Alameri, Fatema Alawadhi, Esat Memisoglu, Ahlam Al Marzooqi","doi":"10.1093/mrcr/rxaf002","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf002","url":null,"abstract":"<p><p>Diffuse idiopathic skeletal hyperostosis (DISH) and axial spondyloarthritis (axSpA) share similarities in both clinical presentation and radiological findings, making the diagnostic process challenging. We report the case of a 30-year-old male with a longstanding history of back pain with an initial diagnosis of young-onset DISH. However, a diagnosis of axSpA was ultimately pursued based on his age and clinical presentation. This was further supported by improvement in both ASDAS-ESR and ASDAS-CRP scores at his 6- and 12-month follow ups on ixekizumab. Early and accurate diagnosis of axSpA, followed by appropriate treatment, is essential in preventing complications and improving patient outcomes.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a Left Anterior Descending Artery Aneurysm in Behçet's Disease: A Case Report.","authors":"Ahmed Hussein Subki, Abdurahman Albeity, Israa Mohammed Mulla, Nabeel Hashim Ismaeil, Muhannad Basheer Qarah, Hussein Halabi","doi":"10.1093/mrcr/rxaf003","DOIUrl":"https://doi.org/10.1093/mrcr/rxaf003","url":null,"abstract":"<p><p>Behçet's disease (BD) is a chronic, relapsing, systemic vasculitis of unknown etiology that affects blood vessels of all sizes, potentially leading to severe complications such as coronary artery aneurysms. This report describes the case of a 33-year-old woman with BD who presented with recurrent chest pain. Imaging revealed a large saccular aneurysm in the left anterior descending artery. Management involved multiple percutaneous coronary interventions to stabilize the aneurysm, alongside infliximab, a tumor necrosis factor-alpha inhibitor, to control the underlying vasculitis. The patient has remained in clinical remission for over three years, providing additional evidence supporting the role of infliximab in addressing vascular complications in BD. This case highlights the challenges in managing coronary artery aneurysms in BD and emphasizes the need for further research into the long-term safety and efficacy of infliximab for such cases.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the letter from Suzuki K et al.","authors":"Koto Hattori, Shigeru Tanaka, Hiroshi Nakajima","doi":"10.1093/mrcr/rxae052","DOIUrl":"10.1093/mrcr/rxae052","url":null,"abstract":"","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"66-67"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tense blisters and haemorrhagic bullae as the first manifestation of eosinophilic granulomatosis with polyangiitis.","authors":"Hajime Inokuchi, Mitsuhiro Akiyama, Hiroto Horikawa, Yasushi Kondo, Shuntaro Saito, Jun Kikuchi, Hironari Hanaoka, Yuko Kaneko","doi":"10.1093/mrcr/rxae056","DOIUrl":"10.1093/mrcr/rxae056","url":null,"abstract":"<p><p>Eosinophilic granulomatosis with polyangiitis poses a significant diagnostic challenge due to its varied clinical presentation. Here, we present a case of a 59-year-old female with a history of asthma and sinusitis, who manifested with an extremely rare presentation of drastic tense blisters and haemorrhagic bullae alongside purpuric lesions and peripheral neuropathy. Examinations revealed eosinophilia, positive antineutrophil cytoplasmic antibody, and characteristic pathological findings with small-vessel vasculitis in the purpura. Treatment with glucocorticoids and cyclophosphamide led to rapid improvement in peripheral eosinophilia, skin manifestations, and motor neuron deficits. Although rare, our case underscores that bullous skin lesions should be recognised as a potential cutaneous hallmark of eosinophilic granulomatosis with polyangiitis to aid timely diagnosis, since prompt treatment initiation is crucial given the potential irreversible organ damage and poor prognosis of eosinophilic granulomatosis with polyangiitis.</p>","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":"149-154"},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}