Safe and successful treatment of refractory polyarteritis nodosa with tocilizumab in a patient with past hepatitis B vir
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CASE BASED REVIEW
Safe and successful treatment of refractory polyarteritis nodosa with tocilizumab in a patient with past hepatitis B virus infection: a case-based review I. Carrión-Barberà 1 J. Monfort 1
&
A. Pros 1 & T. C. Salman-Monte 1 & F. Vílchez-Oya 1 & J. M. Sánchez-Schmidt 2 & C. Pérez-García 1 &
Received: 3 July 2020 / Revised: 4 August 2020 / Accepted: 11 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Polyarteritis nodosa is a primary systemic necrotizing vasculitis whose evolution follows, in many cases, a chronic remittingrecurrent course with refractoriness to conventional immunosuppressants. We report here the clinical case of a 75-year-old patient with serologies suggestive of past hepatitis B virus infection who presented a flare of polyarteritis nodosa with great secondary functional impairment. She had not responded to several previous immunosuppressants and required high doses of glucocorticoids to control the flare. After the initiation of biological therapy with tocilizumab, the patient experienced a rapid and marked clinical and analytical improvement, going into clinical remission and being able to remarkably lower the corticosteroid dose and stop the rest of the immunosuppressants. There was no evidence of hepatitis B virus reactivation or changes in the titers of any of the parameters related to the aforementioned infection. This clinical case represents the first case reported in the literature about the successful and safe treatment of polyarteritis nodosa with tocilizumab in a patient with serologies suggestive of past hepatitis B virus infection. Keywords Anti-interleukin-6 . Biological treatment . Hepatitis B virus . Polyarteritis nodosa . Tocilizumab . Vasculitis
Introduction Polyarteritis nodosa (PAN) is defined as a necrotizing arteritis of medium or small arteries that is not associated with glomerulonephritis or with positivity of anti-neutrophil cytoplasmic antibodies (ANCA) [1]. It usually conditions a multi-organ disease in which the most frequent manifestations involve the skin, joints, muscles, and the peripheral nervous and digestive systems, while the lung is not usually affected. Subtypes characterized by involvement of a single organ, or exclusively cutaneous, are also distinguished [2]. Currently, there are no defined clinical guidelines for the treatment of PAN, and the therapeutic regimens used in it are
* I. Carrión-Barberà [email protected] 1
Rheumatology Department, Hospital del Mar/Parc de Salut Mar, Barcelona, Spain
2
Dermatology Department, Hospital del Mar/Parc de Salut Mar, Barcelona, Spain
frequently extrapolated from the treatment of ANCAassociated vasculitis (AAV) [3]. Few studies have been carried out with the aim of evaluating the best therapeutic options in PAN, and the vast majority of them focus on the role of systemic glucocorticoids (GC) and cyclophosphamide (CYC) [4, 5]. Cases of cutaneous PAN are usually treated with nonsteroidal anti-inflammatory drugs or colchicine and, when refractory, wit
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