成人型史迪爾症合併持續皮疹

Hemophagocytic syndrome as the initial manifestation of systemic lupus erythematosus

生物製劑已知會增加類風溼性關節炎病患潛隱性結核復發的危險。結核感染篩檢與防治共識建議類風溼性關節炎病患接受生物製劑之前必須接受有效的篩檢。我們在此報告一個案，一位49歲女性病患，她在接受復邁和安挺樂等生物製劑前的結核感染篩檢包含QuantiFERON試驗都是陰性。她接受安挺樂治療八個月之後發生乾咳、發燒和右側肋膜積水。肋膜積液的肺結核培養、耐酸桿菌塗片和聚合酶連鎖反應都是陰性而由胸腔鏡手術診斷出結核性肋膜炎。

Biologics are known to increase the risk of reactivation of latent tuberculosis (TB) infection in rheumatoid arthritis (RA) patients. Guidelines have recommended that effective TB screening should be routinely carried out in RA patients before receiving biologics. A 49-year-old woman was admitted due to acute onset of fever, dry cough, and right pleural effusion. She was diagnosed with RA at 47 years of age. She had been treated with adalimumab for 5 months 1 year after diagnosis, but the regimen was stopped due to pneumonia. She was then treated with tocilizumab for the most recent 8 months. TB screening before using adalimumab and tocilizumab, including Quantiferon-TB-Gold in tube tests was negative. Chest computed tomography revealed consolidation in right lower lung field with cavitation, and right pleural effusion with thickened pleura. The pleural effusion were negative for acid-fast stain, TB culture and polymerase chain reaction. Thoracoscopic decortication of the pleura was performed and tuberculous pleurisy was diagnosed. Patients with RA who were treated with biologics are vulnerable to TB. The use of Quantiferon-TB-Gold in tube test for the diagnosis of TB pleurisy was not recommended.