期刊
INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES
卷 -, 期 -, 页码 -出版社
WILEY
DOI: 10.1111/1756-185X.14887
关键词
granuloma; granulomatosis with polyangiitis; Rituximab
类别
This case report describes a relapse of granulomatosis with polyangiitis (GPA) with intracranial granulomatous lesions in a patient under maintenance therapy with Rituximab (RTX), suggesting limited efficacy of RTX for granulomatous manifestations in GPA.
BackgroundRituximab (RTX) is being used for both induction and maintenance of anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis. However, the efficacy of RTX for the granulomatous findings of granulomatosis with polyangiitis (GPA) has not been demonstrated as clearly as its vasculitic manifestations. Case summaryA 46-year-old man was diagnosed in 2019 with GPA with constitutional symptoms, bilateral mastoiditis, prostatic necrosis, nodules in both lungs, pauci-immune necrotizing glomerulonephritis and high level of PR3-ANCA. He reached clinical remission after induction with high-dose corticosteroids and intravenous cyclophosphamide pulses at the 3rd month. Two months following the second cycle of RTX as maintenance, he developed multiple cranial mass lesions, and excisional biopsy revealed necrotizing vasculitis with granuloma formation. Remission was achieved with long-term high-dose corticosteroid therapy after surgical excision. ConclusionWe observed a relapse of GPA with intracranial granulomatous lesions in a patient under RTX maintenance. Limited efficacy of RTX should be considered for mainly granulomatous manifestations in patients with GPA.
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