Uspešna primena rituksimaba kod bolesnika sa teškom refraktarnom formom granulomatoze sa poliangiitisom

  • Jasna Bolpačić Faculty of Medicine, University of Belgrade Clinic for Allergology and Immunology, Clinical Center of Serbia
  • Nevena Savić Dr
  • Snežana Aranđelović Prof. dr
  • Vesna Tomić-Spirić Prof. dr
  • Sanvila Rašković Prof. dr
  • Aleksandra Perić-Popadić Prof. dr
DOI: https://doi.org/10.2298/VSP151224048B
Ključne reči: vegenerova granulomatoza, lečenje, biološka terapija, rituksimab, lečenje, ishod

Sažetak


Apstrakt

 

Uvod. Wegener-ova granulomatoza je oboljenje koje karakterišu granulomatozna inflamacija gornjih i/ili donjih disajnih puteva, glomerulonefritis, uz različit stepen vaskulitisa malih krvnih sudova i nalaz c antineutrofilnih citoplazmatskih antitela (ANCA). U lečenju se koriste različiti modaliteti imunosupresivne terapije koji ne dovode uvek do remisije. Prikazana je efikasnost biološke terapije kod bolesnika sa refraktarnom formom Wegener-ove granulomatoze. Prikaz bolesnika. Bolesnik, star 23 godine, lečen je avgusta 2011. godine na Klinici za otorinolaringologiju i maksilofacijalnu hirurgiju Kliničkog Centra Srbije zbog gnojne upale srednjeg uva. U dva navrata je rađena masteidektomija, a sedmog dana nakon operacije došlo do pojave hemoptizije i febrilnosti. S ozirom na rendgentski snimak pluća na kome su viđene okrugle mekotkivne promene obostrano, laboratorijske analize koje su ukazale na nespecifični zapaljenski sindrom i pozitivne c ANCA (1 : 160) uz povišen titar antitela protiv proteinaze 3 (anti-PR3 antitela), postavljena je dijagnoza Wegener-ova granulomatoze. S obzirom na to da primena glikokortikoida, ciklofosfamida, imunomodulatorne doze imunoglo­bu­li­na nisu doveli do kliničke remisije, odlučeno je da se pri­meni rituksimab. Nakon njegove primene uspostavljena je klinička remisija koja je trajala petnaest meseci. Zaključak. Primena biološke terapije može biti uspešna u lečenju bolesnika sa teškom refraktarnom formom granulomatoze sa poliangiitisom.

Biografije autora

Jasna Bolpačić, Faculty of Medicine, University of Belgrade Clinic for Allergology and Immunology, Clinical Center of Serbia

University of Belgrade, School of Medicine

Clinic of Allergology and Immunology, Clinical Center of Serbia

Nevena Savić, Dr

University of Belgrade, School of Medicine

Snežana Aranđelović, Prof. dr

University of Belgrade, School of Medicine

Clinic of Allergology and Immunology, Clinical Center of Serbia

Vesna Tomić-Spirić, Prof. dr

University of Belgrade, School of Medicine

Clinic of Allergology and Immunology, Clinical Center of Serbia

Sanvila Rašković, Prof. dr

University of Belgrade, School of Medicine

Clinic of Allergology and Immunology, Clinical Center of Serbia

Aleksandra Perić-Popadić, Prof. dr

University of Belgrade, School of Medicine

Clinic of Allergology and Immunology, Clinical Center of Serbia

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Objavljeno
2021/01/26
Broj časopisa
Vol. 75 Br. 7 (2018): Vojnosanit Pregl 2018; July Vol. 75 (No. 7)
Rubrika
Prikaz bolesnika