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Cheng T, Zhi H, Liu Y, Zhang S, Song Z, Li Y. Dual Anti-Glomerular Basement Membrane and Anti-Neutrophil Cytoplasmic Antibodies-Positive Rapidly Progressive Glomerulonephritis with Rheumatoid Arthritis and Sjogren's Syndrome: A Case Report and Literature Review. J Clin Med 2022; 11:jcm11226793. [PMID: 36431270 PMCID: PMC9697768 DOI: 10.3390/jcm11226793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Rapidly progressive glomerulonephritis (RPGN) is a life-threatening disease characterized by rapid progressive deterioration of renal function and extensive formation of crescents. Some antibodies tend to be positive, such as a perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) and anti-glomerular basement membrane (anti-GBM) antibodies, in most patients with the disease. However, cases of double positivity for the above antibodies are considered to be rare. In addition, both rheumatoid arthritis (RA) and Sjogren's syndrome (SS) are deemed to be independent immune disorders that can cause renal impairment. Nevertheless, the association between RPGN and these two diseases has not been elucidated in previous studies. Here, we provide a case of RPGN with the concurrence of RA and SS characterized by double positivity in anti-GBM antibodies and p-ANCA. After aggressive treatment with cyclophosphamide, glucocorticoids, and plasma exchange, the patient improved significantly. Despite the malignant event of arteriovenous fistula rupture and bleeding during treatment, the patient survived with renal function recovery for the rest of the follow-up period.
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Affiliation(s)
- Ting Cheng
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan 030000, China
- Key Laboratory of Cellular Physiology, Shanxi Medical University, Ministry of Education, Taiyuan 030000, China
| | - Huiwen Zhi
- Department of Nephrology, Shanxi Provincial People’s Hospital (Fifth Hospital), Shanxi Medical University, Taiyuan 030000, China
| | - Yunxiao Liu
- Department of Pathology, Shanxi Provincial People’s Hospital (Fifth Hospital), Shanxi Medical University, Taiyuan 030000, China
| | - Shengxiao Zhang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan 030000, China
- Key Laboratory of Cellular Physiology, Shanxi Medical University, Ministry of Education, Taiyuan 030000, China
| | - Ziyi Song
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan 030000, China
- Key Laboratory of Cellular Physiology, Shanxi Medical University, Ministry of Education, Taiyuan 030000, China
| | - Yafeng Li
- Department of Nephrology, Shanxi Provincial People’s Hospital (Fifth Hospital), Shanxi Medical University, Taiyuan 030000, China
- Shanxi Provincial Key Laboratory of Kidney Disease, Taiyuan 030000, China
- Core Laboratory, Shanxi Provincial People’s Hospital (Fifth Hospital), Shanxi Medical University, Taiyuan 030000, China
- Academy of Microbial Ecology, Shanxi Medical University, Taiyuan 030000, China
- Correspondence:
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André F, Böckle BC. Sjögren-Syndrom. J Dtsch Dermatol Ges 2022; 20:980-1003. [PMID: 35881105 DOI: 10.1111/ddg.14823_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Fiona André
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Barbara C Böckle
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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André F, Böckle BC. Sjögren's syndrome. J Dtsch Dermatol Ges 2022; 20:980-1002. [PMID: 35775593 PMCID: PMC9539881 DOI: 10.1111/ddg.14823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
Sjögren’s syndrome (SjS) is an autoimmune disease characterized by the triad of sicca symptoms, fatigue and pain. This diagnosis is usually made in women at the average age of 60 years. Diagnosis is made when sicca symptoms persist for more than three months, after the exclusion of possible differential diagnoses, and using the ACR/EULAR 2016 classification criteria for SjS. Many organs can be affected in the course of this disease. Xerosis cutis and pruritus are the most common skin manifestations, followed by leukocytoclastic vasculitis and subacute cutaneous lupus erythematosus. In addition, SjS patients often have myoarthralgia and neuropsychiatric symptoms. In the long term, attention must be paid to the increased risk of cardiovascular disease and lymphoma. Due to the multiorgan involvement in SjS patients, interdisciplinary care is required.
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Affiliation(s)
- Fiona André
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara C Böckle
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
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