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Rheumatoid arthritis complicated with cervical actinomycosis and ureteral obstruction: A case report and literature review. | LitMetric

Rheumatoid arthritis complicated with cervical actinomycosis and ureteral obstruction: A case report and literature review.

Zhong Nan Da Xue Xue Bao Yi Xue Ban

Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China.

Published: May 2024

AI Article Synopsis

  • Actinomycosis is a rare chronic disease that can be confused with other conditions and is characterized by the formation of granulomas and tissue scarring.
  • A 60-year-old woman with a long history of rheumatoid arthritis developed actinomycosis after being treated with immunosuppressive medications, leading to complications like joint pain and elevated white blood cell counts.
  • After an 18-month treatment with doxycycline and ongoing management of her rheumatoid arthritis, the patient showed improvement and remained stable with no recurrence after 2 years, underscoring the need for awareness of rare infections in patients on strong immunosuppressive therapies.

Article Abstract

Actinomycosis is a rare chronic granulomatous disease characterized by granuloma formation and tissue fibrosis with sinus tracts, often misdiagnosed due to its similarity to many infectious and non-infectious diseases. This report presents a case of a 60-year-old female with more than 10 years history of rheumatoid arthritis who developed actinomycosis infection after long-term treatment with immunosuppressants and biologics, including methotrexate, leflunomide, and infliximab, leading to recurrent joint pain, poorly controlled rheumatoid arthritis activity, and persistent elevation of white blood cell counts. Abdominal CT revealed a pelvic mass and right ureteral dilation. Pathological examination of cervical tissue showed significant neutrophil infiltration and sulfur granules, indicating actinomycosis. The patient received 18 months of doxycycline treatment for the infection and continued rheumatoid arthritis therapy with leflunomide, hydroxychloroquine sulfate, and tofacitinib, resulting in improved joint symptoms and normalized white blood cell counts. After 2 years of follow-up, the patient remained stable with no recurrence. This case highlights the importance of clinicians being vigilant for infections, particularly chronic, occult infections from rare pathogens, in rheumatoid arthritis patients on potent immunosuppressants and biologics, advocating for early screening and diagnosis.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341218PMC
http://dx.doi.org/10.11817/j.issn.1672-7347.2024.230501DOI Listing

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