类风湿性多肌痛演变为RS3PE综合征。什么是特发性或继发性,基于mRNA的新冠肺炎疫苗?病例报告及文献综述

M. Turrin, L. Fornasiero, Antonio Navarro
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摘要

我们描述了一名74岁男性患者的临床病例,该患者接受了第二剂comarnaty /Pfizer抗covid -19疫苗。3周后出现风湿病多肌痛的临床症状。病史包括轻度慢性正红细胞、正色贫血和低γ球蛋白血症、骨关节炎、网状脂肪肝、高胆固醇血症和动脉高血压。尽管长期使用非甾体抗炎药和地塞米松治疗,该疾病仍演变为缓解性血清阴性对称滑膜炎伴凹陷性水肿(RS3PE)综合征。排除肿瘤疾病及相关胶原蛋白疾病。在注射Spikevax/Moderna疫苗加强剂后不久,临床症状再次出现。炎症指数高,手部x线片无糜烂,超声检查显示肩部滑囊炎,膝关节滑膜炎,下肢明显皮下水肿,鞘膜积液,双侧腘窝腔贝克氏囊肿,小腿血肿。口服强的松龙后,临床表现明显改善,并与羟氯喹联合稳定。发现持续性低镁血症与长期摄入埃索美拉唑有关。我们考虑了国际数据库中风湿病反应的报告以及文献中描述的COVID-19疫苗后RS3PE综合征的罕见病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Polymyalgia Rheumatica Evolved into RS3PE Syndrome. What is the Culprit: Idiopathic or Secondary, Following mRNA-Based COVID-19 Vaccines? A Case Report and Brief Review of the Literature
We describe the clinical case of a 74-year-old male patient who received the second Comirnaty/Pfizer anti-COVID-19 vaccine dose. After 3 weeks he showed the clinical signs of polymyalgia rheumatica. The history included mild chronic normocytic normochromic anemia and hypogammaglobulinemia, osteoarthritis disease, livedo reticularis, hypercholesterolemia, and arterial hypertension. Despite prolonged treatment with NSAIDs and dexamethasone, the disease evolved into remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Neoplastic diseases and associated collagen diseases were excluded. The clinical picture recurred, soon after, the booster dose of the Spikevax/Moderna vaccine. The inflammatory indices were high, the radiographs of the hands were free of erosions, the ultrasound investigations revealed bursitis of the shoulders, knee synovitis, marked subcutaneous edema of the lower limbs, hydrocele, bilateral Baker's cyst in the popliteal cavity, hematoma of a calf. The clinical picture, markedly improved, with oral prednisolone and was stabilized with the association of hydroxychloroquine. The finding of persistent hypomagnesemia was related to chronic intake of esomeprazole. The reports of rheumatological reactions in international databases and the rare cases of RS3PE syndrome following the COVID-19 vaccine described in the literature are considered.
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