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Hypogammaglobulinaemia and various infections: 2 case reports In a report, two women were described; A woman in her 40’s (patient 1) developed hypogammaglobulinaemia during treatment with leflunomide, methotrexate and sulfasalazine for rheumatoid arthritis (RA). She also developed oral candidiasis, unspecified skin infections with abscess, shingles and pneumonia during treatment with prednisone and prednisolone for RA. The other woman in her 50’s (patient 2) developed hypogammaglobulinaemia during treatment with leflunomide and methotrexate for RA [routes, dosages and time to reaction onsets not stated; not all outcomes stated]. Patient 1: The woman presented in 2017, at the age of 62 years. She was diagnosed with rheumatoid arthritis in 2000. She had been undergoing treatment with methotrexate and prednisolone with subsequent addition of ciclosporin. However, she developed shingles. She developed shingles again, along with pneumonia in 2009 and required out-patient treatment. At the time, her ciclosporin had been discontinued and she was briefly treated with sulfasalazine, followed by leflunomide (administered for 3 months) and abatacept. One year after developing shingles and pneumonia, she developed recurrent unspecified skin infections with abscess which required hospitalisation and surgical treatment. Between 2010 and 2013, her prednisolone was replaced by modified release prednisone [Lodotra]. In 2013, she showed hypogammaglobulinaemia with levels of 5.7–6.5 g/L and normal IgA and IgM levels. Eventually her disease-modifying antirheumatic drugs were discontinued and she was treated with adalimumab and later etanercept. Her blood cell count showed slightly high leukocytes. A flowcytometric phenotyping of lymphocytes showed slightly elevated T-cell counts with normal B-cell counts. She developed recurring oral candidiasis and required immune-globulin supplementation. The supplementation resulted in marked improvement of infections with development of fewer infections. Treatment with disease-modifying antirheumatic drugs, mainly leflunomide, methotrexate and sulfasalazine were thought to play a role in the development of hypogammaglobulinaemia. Additionally, her treatment with prednisone and prednisolone was thought to be a risk factor in development of various infections. Patient 2: The woman presented in 2017, at the age of 62 years. She had been diagnosed with rheumatoid arthritis in 2014. She had been treated with methotrexate, leflunomide (administered for 4 months) and certolizumab-pegol. After initial treatment with unspecified glucocorticoids, the treatment was weaned off. She had remained in remission for 4 years on certolizumab-pegol. In 2017, she was diagnosed with significant hypogammaglobulinaemia with levels of 5.48 g/L. She had not developed infections. Treatment with disease-modifying antirheumatic drugs, mainly leflunomide and methotrexate were thought to play a role in the development of hypogammaglobulinaemia. Krasselt M, et al. Hypogammaglobulinaemia in identical twin sisters with rheuma