Chikungunya fever(CF)is caused by an arbovirus whose manifestations are extremely diverse,and it has evolved with significant severity in recent years.The clinical signs triggered by the Chikungunya virus are similar ...Chikungunya fever(CF)is caused by an arbovirus whose manifestations are extremely diverse,and it has evolved with significant severity in recent years.The clinical signs triggered by the Chikungunya virus are similar to those of other arboviruses.Generally,fever starts abruptly and reaches high levels,followed by severe polyarthralgia and myalgia,as well as an erythematous or petechial maculopapular rash,varying in severity and extent.Around 40%to 60%of affected individuals report persistent arthralgia,which can last from months to years.The symptoms of CF mainly represent the tissue tropism of the virus rather than the immunopathogenesis triggered by the host's immune system.The main mechanisms associated with arthralgia have been linked to an increase in T helper type 17 cells and a consequent increase in receptor activator of nuclear factor kappa-Βligand and bone resorption.This review suggests that persistent arthralgia results from the presence of viral antigens post-infection and the constant activation of signaling lymphocytic activation molecule family member 7 in synovial macrophages,leading to local infiltration of CD4+T cells,which sustains the inflammatory process in the joints through the secretion of pro-inflammatory cytokines.The term"long chikungunya"was used in this review to refer to persistent arthralgia since,due to its manifestation over long periods after the end of the viral infection,this clinical condition seems to be characterized more as a sequel than as a symptom,given that there is no active infection involved.展开更多
BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and rela...BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.展开更多
原发性干燥综合征是一种以外分泌腺损伤为特征的慢性炎症性自身免疫性疾病。干燥综合征起病个体差异性较大,临床症状多样,损伤严重程度各不相同。原发性干燥综合征除了导致腺体损伤外,还可能涉及多个器官和系统,其常见的临床表现之一为...原发性干燥综合征是一种以外分泌腺损伤为特征的慢性炎症性自身免疫性疾病。干燥综合征起病个体差异性较大,临床症状多样,损伤严重程度各不相同。原发性干燥综合征除了导致腺体损伤外,还可能涉及多个器官和系统,其常见的临床表现之一为神经系统症状,中枢神经系统、周围神经系统均可累及。其中干燥综合征首发表现为视神经脊髓炎谱系疾病的情况在临床上较少见,在实际的临床诊疗过程中,询问病史、筛查抗核抗体及抗水通道蛋白4(Aquaporin Protein 4,AQP4)抗体发挥重要的作用。文章报道1例以视神经脊髓炎谱系疾病为首发表现的干燥综合征青年女性患者,该患者以下肢麻木疼痛伴瘙痒为首发表现,多次就诊于皮肤科,发病2个月后才出现干燥症状,确诊后予中西医治疗,治疗后好转,随访1年未见复发。文章通过分析此病例的临床表现、化验检查、诊治预后等,以提高对此类疾病的认识,以便对病情进行早期诊断,以免出现误诊或漏诊,并及时进行中西医联合治疗,控制病情,避免出现不可逆转的损害。同时在此过程中还应注意动态随访,减少复发,提高患者的生活质量。展开更多
文摘Chikungunya fever(CF)is caused by an arbovirus whose manifestations are extremely diverse,and it has evolved with significant severity in recent years.The clinical signs triggered by the Chikungunya virus are similar to those of other arboviruses.Generally,fever starts abruptly and reaches high levels,followed by severe polyarthralgia and myalgia,as well as an erythematous or petechial maculopapular rash,varying in severity and extent.Around 40%to 60%of affected individuals report persistent arthralgia,which can last from months to years.The symptoms of CF mainly represent the tissue tropism of the virus rather than the immunopathogenesis triggered by the host's immune system.The main mechanisms associated with arthralgia have been linked to an increase in T helper type 17 cells and a consequent increase in receptor activator of nuclear factor kappa-Βligand and bone resorption.This review suggests that persistent arthralgia results from the presence of viral antigens post-infection and the constant activation of signaling lymphocytic activation molecule family member 7 in synovial macrophages,leading to local infiltration of CD4+T cells,which sustains the inflammatory process in the joints through the secretion of pro-inflammatory cytokines.The term"long chikungunya"was used in this review to refer to persistent arthralgia since,due to its manifestation over long periods after the end of the viral infection,this clinical condition seems to be characterized more as a sequel than as a symptom,given that there is no active infection involved.
文摘BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.
文摘原发性干燥综合征是一种以外分泌腺损伤为特征的慢性炎症性自身免疫性疾病。干燥综合征起病个体差异性较大,临床症状多样,损伤严重程度各不相同。原发性干燥综合征除了导致腺体损伤外,还可能涉及多个器官和系统,其常见的临床表现之一为神经系统症状,中枢神经系统、周围神经系统均可累及。其中干燥综合征首发表现为视神经脊髓炎谱系疾病的情况在临床上较少见,在实际的临床诊疗过程中,询问病史、筛查抗核抗体及抗水通道蛋白4(Aquaporin Protein 4,AQP4)抗体发挥重要的作用。文章报道1例以视神经脊髓炎谱系疾病为首发表现的干燥综合征青年女性患者,该患者以下肢麻木疼痛伴瘙痒为首发表现,多次就诊于皮肤科,发病2个月后才出现干燥症状,确诊后予中西医治疗,治疗后好转,随访1年未见复发。文章通过分析此病例的临床表现、化验检查、诊治预后等,以提高对此类疾病的认识,以便对病情进行早期诊断,以免出现误诊或漏诊,并及时进行中西医联合治疗,控制病情,避免出现不可逆转的损害。同时在此过程中还应注意动态随访,减少复发,提高患者的生活质量。