Therapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infection
Introduction. The objective of this case report is to present a clinical course of SARS-CoV-2 infection in a patient with long-term rheumatoid arthritis and concomitant rituximab therapy. Case outline. A 58-year-old female patient was diagnosed with seropositive rheumatoid arthritis at the age of 35...
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| Format: | Article |
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Serbian Medical Society
2023-01-01
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| Series: | Srpski Arhiv za Celokupno Lekarstvo |
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| Online Access: | https://doiserbia.nb.rs/img/doi/0370-8179/2023/0370-81792300016J.pdf |
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| author | Janković Tanja Savić Aleksandra Zvekić-Svorcan Jelena Glavčić Aleksandra Bošković Ksenija |
| author_facet | Janković Tanja Savić Aleksandra Zvekić-Svorcan Jelena Glavčić Aleksandra Bošković Ksenija |
| author_sort | Janković Tanja |
| collection | DOAJ |
| description | Introduction. The objective of this case report is to present a clinical course of SARS-CoV-2 infection in a patient with long-term rheumatoid arthritis and concomitant rituximab therapy. Case outline. A 58-year-old female patient was diagnosed with seropositive rheumatoid arthritis at the age of 35. She was primarily prescribed chloroquine and glucocorticoid, afterwards methotrexate and biological agent – etanercept. Because of a secondary loss of response, etanercept was switched to rituximab. She had 13 cycles of rituximab and the last was given in June 2020. In December 2020, she was hospitalized due to bilateral pneumonia and respiratory insufficiency. The results of the laboratory analysis revealed anemia, leukocytosis, thrombocytosis, and markedly elevated C-reactive protein, procalcitonin, D-dimer, transaminases. The findings of the chest computed tomography scan were consistent with COVID-19 pneumonia features with accompanying bilateral pleural effusion. The patient was treated with antibiotics, corticosteroids, tocilizumab, hepatoprotective, gastroprotective, oxygen therapy, and parenteral anticoagulant. Three months after recovering from pneumonia, she developed arthritis flare, hence a JAK inhibitor, baricitinib, was started. Low disease activity was achieved with baricitinib monotherapy. Conclusion. Due to risk of severe COVID-19, caution may be required when applying immunosuppressive therapy in patients with rheumatic diseases. |
| first_indexed | 2024-03-13T06:24:06Z |
| format | Article |
| id | doaj.art-ba648f7dafb84ac995df85dc0b549bee |
| institution | Directory Open Access Journal |
| issn | 0370-8179 2406-0895 |
| language | English |
| last_indexed | 2024-03-13T06:24:06Z |
| publishDate | 2023-01-01 |
| publisher | Serbian Medical Society |
| record_format | Article |
| series | Srpski Arhiv za Celokupno Lekarstvo |
| spelling | doaj.art-ba648f7dafb84ac995df85dc0b549bee2023-06-09T10:43:47ZengSerbian Medical SocietySrpski Arhiv za Celokupno Lekarstvo0370-81792406-08952023-01-011513-422322610.2298/SARH221204016J0370-81792300016JTherapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infectionJanković Tanja0Savić Aleksandra1Zvekić-Svorcan Jelena2https://orcid.org/0000-0002-3489-4351Glavčić Aleksandra3Bošković Ksenija4https://orcid.org/0000-0002-6362-4895University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Special Hospital for Rheumatic Diseases, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Special Hospital for Rheumatic Diseases, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Special Hospital for Rheumatic Diseases, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Special Hospital for Rheumatic Diseases, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Special Hospital for Rheumatic Diseases, Novi Sad, SerbiaIntroduction. The objective of this case report is to present a clinical course of SARS-CoV-2 infection in a patient with long-term rheumatoid arthritis and concomitant rituximab therapy. Case outline. A 58-year-old female patient was diagnosed with seropositive rheumatoid arthritis at the age of 35. She was primarily prescribed chloroquine and glucocorticoid, afterwards methotrexate and biological agent – etanercept. Because of a secondary loss of response, etanercept was switched to rituximab. She had 13 cycles of rituximab and the last was given in June 2020. In December 2020, she was hospitalized due to bilateral pneumonia and respiratory insufficiency. The results of the laboratory analysis revealed anemia, leukocytosis, thrombocytosis, and markedly elevated C-reactive protein, procalcitonin, D-dimer, transaminases. The findings of the chest computed tomography scan were consistent with COVID-19 pneumonia features with accompanying bilateral pleural effusion. The patient was treated with antibiotics, corticosteroids, tocilizumab, hepatoprotective, gastroprotective, oxygen therapy, and parenteral anticoagulant. Three months after recovering from pneumonia, she developed arthritis flare, hence a JAK inhibitor, baricitinib, was started. Low disease activity was achieved with baricitinib monotherapy. Conclusion. Due to risk of severe COVID-19, caution may be required when applying immunosuppressive therapy in patients with rheumatic diseases.https://doiserbia.nb.rs/img/doi/0370-8179/2023/0370-81792300016J.pdfinflammatory diseasesrheumatoid arthritisimmunosuppressive drugcovid-19 |
| spellingShingle | Janković Tanja Savić Aleksandra Zvekić-Svorcan Jelena Glavčić Aleksandra Bošković Ksenija Therapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infection Srpski Arhiv za Celokupno Lekarstvo inflammatory diseases rheumatoid arthritis immunosuppressive drug covid-19 |
| title | Therapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infection |
| title_full | Therapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infection |
| title_fullStr | Therapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infection |
| title_full_unstemmed | Therapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infection |
| title_short | Therapeutic dilemmas in the management of a patient with long-term rheumatoid arthritis and severe clinical presentation of SARS-CoV-2 infection |
| title_sort | therapeutic dilemmas in the management of a patient with long term rheumatoid arthritis and severe clinical presentation of sars cov 2 infection |
| topic | inflammatory diseases rheumatoid arthritis immunosuppressive drug covid-19 |
| url | https://doiserbia.nb.rs/img/doi/0370-8179/2023/0370-81792300016J.pdf |
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