Tang PF, Xu LC, Hong WT, Shi HY. Successful treatment of granulomatosis with polyangiitis using tocilizumab combined with glucocorticoids: A case report. World J Clin Cases 2023; 11(5): 1144-1151 [PMID: 36874435 DOI: 10.12998/wjcc.v11.i5.1144]
Corresponding Author of This Article
Hong-Ying Shi, PhD, Chief Physician, Department of Immunology, Second Affiliated Hospital of Fujian Medical University, Donghai Street, Fengze District, Quanzhou 362000, Fujian Province, China. shyfly@163.com
Research Domain of This Article
Rheumatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 16, 2023; 11(5): 1144-1151 Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1144
Successful treatment of granulomatosis with polyangiitis using tocilizumab combined with glucocorticoids: A case report
Peng-Fang Tang, Long-Chuan Xu, Wen-Ting Hong, Hong-Ying Shi
Peng-Fang Tang, Wen-Ting Hong, Department of Rheumatology, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Long-Chuan Xu, Department of Pathology, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Hong-Ying Shi, Department of Immunology, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Author contributions: Tang PF contributed to manuscript writing and editing, and data collection; Xu LC contributed to data analysis; Shi HY and Hong WT contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Ying Shi, PhD, Chief Physician, Department of Immunology, Second Affiliated Hospital of Fujian Medical University, Donghai Street, Fengze District, Quanzhou 362000, Fujian Province, China. shyfly@163.com
Received: October 27, 2022 Peer-review started: October 27, 2022 First decision: November 25, 2022 Revised: December 3, 2022 Accepted: January 28, 2023 Article in press: January 28, 2023 Published online: February 16, 2023 Processing time: 109 Days and 17.4 Hours
Abstract
BACKGROUND
Tocilizumab is a humanized monoclonal antibody against the interleukin-6 (IL-6) receptor that is commonly used to treat large vessel vasculitis and antineutrophil cytoplasmic antibody-related small vessel vasculitis. However, tocilizumab in combination with glucocorticoids for successfully treating granulomatosis with polyangiitis (GPA) has rarely been reported.
CASE SUMMARY
Here, we report a 40-year-old male patient who suffered GPA for 4 years. He was treated with multiple rounds of drugs, including cyclophosphamide, Tripterygium wilfordii, mycophenolate mofetil, and belimumab, with no improvement. In addition, he exhibited persistently high IL-6 levels. After tocilizumab treatment, his symptoms improved, and his inflammatory marker levels returned to normal.
Core Tip: Granulomatosis with polyangiitis (GPA), formerly called Wegener's granulomatosis, is a necrotizing granulomatous vasculitis that involves small arteries, veins, and capillaries throughout the body. The upper respiratory tract, lower respiratory tract, and kidney are most commonly affected. Clinically, glucocorticoid combined with cyclophosphamide is the first treatment for GPA. Herein, we report a case of refractory GPA. Combined with the literature review, we found that interleukin-6 (IL-6) levels were generally elevated in GPA patients. IL-6 is involved in the pathogenesis of antineutrophil cytoplasmic antibody-related small vessel vasculitis. We successfully treated a patient with refractory GPA using the IL-6 inhibitor-tocilizumab. Tocilizumab is an option when conventional immunosuppressants and rituximab are not effective in treating GPA.
