Modern rheumatology case reports最新文献_第3页

A case of newly onset rheumatoid arthritis successfully treated with methotrexate under the antiretrovirus therapy against HIV infection. 甲氨蝶呤在抗逆转录病毒治疗下成功治疗新发类风湿性关节炎1例。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf011

Ippei Miyagawa, Shingo Nakayamada, Kazuyoshi Saito, Shoichi Shimizu, Kentaro Hanami, Masanobu Ueno, Yoshiya Tanaka

{"title":"A case of newly onset rheumatoid arthritis successfully treated with methotrexate under the antiretrovirus 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":"10.1093/mrcr/rxaf011","url":null,"abstract":"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. Antiretroviral therapy 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 methotrexate, 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, 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.","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-25","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}

引用次数: 0

Glucocorticoid sparing effect on adalimumab for refractory pyoderma gangrenosum in patients with rheumatoid arthritis: A case series. 阿达木单抗对类风湿关节炎患者顽固性坏疽性脓皮病的糖皮质激素节约作用：一个病例系列。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxae075

Shin-Ichiro Ohmura, Naomi Morishita, Haruka Yonezawa, Toshitaka Yukishima, Yusuke Ohkubo

引用次数: 0

Constrictive pericarditis as first presentation of IgG4-related disease: Pitfalls and pearls. 缩窄性心包炎是igg4相关疾病的首次表现：陷阱和珍珠

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxae089

Timothy N Kwan, Gemma Kwan, John Yiannikas

引用次数: 0

Low-density lipoprotein apheresis for refractory lupus nephritis: A case demonstrating marked improvement in proteinuria, haematuria, and kidney function. 低密度脂蛋白穿刺治疗难治性狼疮肾炎：一例显示蛋白尿、血尿和肾功能显著改善。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf009

Narumichi Iwamura, Yuta Matsukuma, Kanako Tsutsumi, Narumi Higashi, Seiya Shomura, Noriko Uesugi, Takafumi Hamashoji, Yui Arita, Takashi Deguchi, Toshiaki Nakano

{"title":"Low-density lipoprotein apheresis for refractory lupus nephritis: A case demonstrating marked improvement in proteinuria, haematuria, and kidney function.","authors":"Narumichi Iwamura, Yuta Matsukuma, Kanako Tsutsumi, Narumi Higashi, Seiya Shomura, Noriko Uesugi, Takafumi Hamashoji, Yui Arita, Takashi Deguchi, Toshiaki Nakano","doi":"10.1093/mrcr/rxaf009","DOIUrl":"10.1093/mrcr/rxaf009","url":null,"abstract":"Systemic lupus erythematosus (SLE) predominantly involves the kidneys, causing lupus nephritis (LN). Patients with diffuse proliferative LN frequently experience poor outcomes despite advances in immunosuppressive therapies. Low-density lipoprotein apheresis (LDL-A) has been a potential therapeutic option for steroid-resistant nephrotic syndromes (NSs), but its efficacy in LN remains unknown. Here, we report the case of a 26-year-old female patient with SLE and LN classified as IV + V (G) A/C according to the renal pathology society, who developed refractory NS, severe haematuria, and declining renal function. The initial induction therapy, which included hydroxychloroquine, glucocorticoids, mycophenolate mofetil, and belimumab, proved to be ineffective. Consequently, LDL-A significantly improved proteinuria, haematuria, and kidney function. The urinary protein-to-creatinine ratio decreased from 7.15 to 0.61 g/gCr, and haematuria dropped from >100 to 10-19 erythrocytes per high-power field. Additionally, complement levels were improved and anti-double-stranded DNA antibody titres were reduced. Ascribing these improvements solely to LDL-A remains challenging, but the rapid proteinuria and haematuria reduction within 48 h indicates a substantial contribution of LDL-A to the clinical response. The effluent from LDL-A contained not only LDL cholesterol but also measurable amounts of immunoglobulin G and M, which may have contributed to the reduction in LN activity. This case represents the first report of a marked haematuria reduction following LDL-A in LN. LDL-A is a valuable adjunctive treatment in patients with refractory NS or highly active LN unresponsive to standard induction therapies.","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366230","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}

引用次数: 0

Necrotising renal vasculitis associated with sarcoidosis in a patient with oesophageal cancer: A case report. 食管癌患者坏死性肾血管炎合并结节病1例报告。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf018

Tsuneo Sasai, Ryosuke Hiwa, Shion Kachi, Yoko Shimizu, Shinya Yamamoto, Yuki Teramoto, Mirei Shirakashi, Hideaki Tsuji, Shuji Akizuki, Ran Nakashima, Hajime Yoshifuji, Motoko Yanagita, Akio Morinobu

{"title":"Necrotising renal vasculitis associated with sarcoidosis in a patient with oesophageal cancer: A case report.","authors":"Tsuneo Sasai, Ryosuke Hiwa, Shion Kachi, Yoko Shimizu, Shinya Yamamoto, Yuki Teramoto, Mirei Shirakashi, Hideaki Tsuji, Shuji Akizuki, Ran Nakashima, Hajime Yoshifuji, Motoko Yanagita, Akio Morinobu","doi":"10.1093/mrcr/rxaf018","DOIUrl":"10.1093/mrcr/rxaf018","url":null,"abstract":"Sarcoidosis is a multisystem disorder characterised by noncaseating granulomas, often involving the lungs and lymph nodes, but can affect nearly any organ. Renal involvement in sarcoidosis typically presents as hypercalcaemia or interstitial granulomatous nephritis. Renal vasculitis, however, is an exceedingly rare manifestation. We present a case of a 74-year-old Japanese male who was diagnosed with oesophageal cancer and underwent chemoradiotherapy. He presented with hypercalcaemia and renal dysfunction, and laboratory tests revealed elevated serum creatinine and hypercalcaemia. Fluorodeoxyglucose-positron emission tomography/computed tomography showed intense uptake in the gluteal and adductor muscles, with no recurrence of oesophageal cancer. A muscle biopsy confirmed non-necrotising granulomas. Despite correction of hypercalcaemia, proteinuria and renal dysfunction persisted, prompting a renal biopsy. The biopsy revealed pauci-immune vasculitis, with fibrin deposition and destruction of the vascular elastic lamina, without granulomas. The patient was treated with corticosteroids, which led to significant improvement in renal function and proteinuria. This case highlights the rare coexistence of sarcoidosis and renal vasculitis. Thus, even in the presence of mild urinary abnormalities, renal biopsy should be considered in the diagnostic approach to sarcoidosis patients with renal dysfunction.","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569264","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}

引用次数: 0

Atypical lymphoproliferative disorder and acquired angioedema in systemic lupus erythematosus and Sjögren's syndrome: A diagnostic challenge. 系统性红斑狼疮和Sjögren综合征的非典型淋巴增生性疾病和获得性血管性水肿：诊断挑战。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf022

Junya Kitai, Takahiro Seno, Masataka Kohno, Keiko Hashimoto, Shinsuke Mizutani, Junya Kuroda, Yasufumi Masaki, Yutaka Kawahito

{"title":"Atypical lymphoproliferative disorder and acquired angioedema in systemic lupus erythematosus and Sjögren's syndrome: A diagnostic challenge.","authors":"Junya Kitai, Takahiro Seno, Masataka Kohno, Keiko Hashimoto, Shinsuke Mizutani, Junya Kuroda, Yasufumi Masaki, Yutaka Kawahito","doi":"10.1093/mrcr/rxaf022","DOIUrl":"10.1093/mrcr/rxaf022","url":null,"abstract":"We report a case of a 33-year-old woman presenting with facial erythema, pharyngitis, and progressive cervical lymphadenopathy with tongue, pharyngeal, and laryngeal edema. Laboratory evaluations revealed an elevated soluble interleukin-2 receptor level, positive antinuclear, double-stranded DNA, Sjögren's syndrome-related antigen A antibodies, and decreased complement levels. Salivary gland studies confirmed Sjögren's syndrome, and together with serological findings, the patient fulfilled criteria for systemic lupus erythematosus. Although Positron emission tomography-computed tomography findings raised suspicion for malignant lymphoma, a cervical lymph node biopsy demonstrated interfollicular expansion, proliferation of small blood vessels with prominent endothelial cells, and large immunoblasts, consistent with atypical lymphoplasmacytic and immunoblastic proliferation. Despite clinical evidence of angioedema on endoscopic examination, complement levels and C1-inhibitor activity were normal, suggesting a non-complement-mediated mechanism. The patient was initially treated with hydroxychloroquine for systemic lupus erythematosus; however, worsening symptoms required prednisolone therapy, leading to significant clinical improvement. Recurrence during steroid tapering was managed by adjusting the steroid dose and adding mycophenolate mofetil. This case emphasises the importance of comprehensive evaluation to differentiate atypical lymphoplasmacytic and immunoblastic proliferation from malignant lymphoma and to recognise atypical acquired angioedema in autoimmune disease.","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145334","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}

引用次数: 0

Myocardial infarction and leg amputation due to critical limb ischaemia as an initial manifestation of granulomatosis with polyangiitis. 多血管炎肉芽肿病的一个初始表现是严重肢体缺血引起的心肌梗死和截肢。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf031

Maria Chiara Ditto, Richard Borrelli, Lorenzo Gibello, Antonella Barreca, Elena Boaglio, Manuel Burdese, Emanuela Maddalena, Luigi Biancone, Enrico Fusaro, Simone Parisi

{"title":"Myocardial infarction and leg amputation due to critical limb ischaemia as an initial manifestation of granulomatosis with polyangiitis.","authors":"Maria Chiara Ditto, Richard Borrelli, Lorenzo Gibello, Antonella Barreca, Elena Boaglio, Manuel Burdese, Emanuela Maddalena, Luigi Biancone, Enrico Fusaro, Simone Parisi","doi":"10.1093/mrcr/rxaf031","DOIUrl":"10.1093/mrcr/rxaf031","url":null,"abstract":"Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis primarily affecting the respiratory tract and kidneys. This case report describes a severe and atypical presentation of GPA in a 42-year-old male, who initially presented with sudden onset of cough, myalgia, dysaesthesia, and lower limb oedema. Initial tests indicated elevated inflammatory markers and white blood cell count. Subsequent imaging revealed a suspicious pulmonary nodule, but the patient experienced a syncopal episode and myocardial infarction before scheduled surgery. Despite normal myocardial biopsy results and negative bacterial/viral tests, the patient developed ischaemic symptoms in the lower extremities, leading to severe limb ischaemia and amputation of the left distal third thigh. Few days later he developed renal involvement with proteinuria, haematuria, active urinary sediment, and rapidly progressive renal dysfunction. The clinical scenario and the detection of high-titre antineutrophil cytoplasmatic antibodies (ANCA) were highly suggestive for GPA; despite the lack of histological confirmation due to mandatory anticoagulant treatment for the recent myocardial event, treatment with methylprednisolone and rituximab was started and led to rapid clinical improvement. Subsequently histological analysis of the amputated leg confirmed necrotising vasculitis. This case highlights the importance of considering GPA in differential diagnoses involving multiorgan symptoms and underscores the complexities in diagnosing and managing this rare condition, especially when typical diagnostic biopsies are not feasible.","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201198","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}

引用次数: 0

Successful glucocorticoid treatment case for IgG4-related long-standing optic neuropathy. 糖皮质激素治疗igg4相关性长期视神经病变成功一例。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf015

Soma Fukami, Shin-Ichiro Ohmura, Toshitaka Yukishima, Takuto Hamada, Yoshiro Otsuki, Noriyoshi Ogawa

引用次数: 0

A case of tattoo-related sarcoidosis with generalised lymph node enlargement. 纹身相关结节病伴全身淋巴结肿大1例。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf036

Ukyo Yamamoto, Daisuke Ikuma, Yuki Oba, Hiroki Mizuno, Akinari Sekine, Masayuki Yamanouchi, Eiko Hasegawa, Suwa Tatsuya Suwabebe, Kei Kono, Kenichi Ohashi, Takehiko Wada, Naoki Sawa, Yoshifumi Ubara

引用次数: 0

Granulomatosis with polyangiitis initially presenting as frequent urination mimicking a prostatic abscess: A case report. 肉芽肿病合并多血管炎最初表现为尿频模仿前列腺脓肿一例报告。

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Modern rheumatology case reports Pub Date : 2025-07-25 DOI: 10.1093/mrcr/rxaf010

Riko Kamada, Makoto Hibino, Hikari Higa, Shigehiro Watanabe, Kazunari Maeda, Shunichi Tobe, Takuya Kakutani, Tetsuri Kondo

{"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, Shunichi Tobe, Takuya Kakutani, Tetsuri Kondo","doi":"10.1093/mrcr/rxaf010","DOIUrl":"10.1093/mrcr/rxaf010","url":null,"abstract":"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 proteinase-3-anti-neutrophil cytoplasmic antibody 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 embolised 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.","PeriodicalId":94146,"journal":{"name":"Modern rheumatology case reports","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-25","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}

引用次数: 0