Refractory PMR with aortitis: life-saving treatment with anti-IL6 monoclonal antibody (tocilizumab) and surgical reconstruction of the ascending aorta.

Abstract

Aortitis is uncommon but well described in patients with polymyalgia rheumatica (PMR). While glucocorticoid remains the mainstay therapy for large-vessel vasculitis, there have been cases where tocilizumab therapy led to clinical and serological improvement in patients with relapsing or refractory disease. We report a case of life-threatening PMR with aortitis in the absence of manifestations related to giant cell arteritis, which, having failed to respond to corticosteroid therapy, was successfully treated with tocilizumab and emergency reconstruction of the ascending aorta. This case adds to the literature supporting the potential value of interleukin-6 inhibition in rare rheumatological conditions such as inflammatory aortitis.

• Authors: Fahd Adeeb Mohamed Ashraf, Shakeel Anjum, Abid Hussaini, Alexander Fraser
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2013 (Jun 18 2013) ISSN: 1757-790X [Electronic] England
• PMID: 23780768 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Interleukin-6
• tocilizumab

Topics

• Antibodies, Monoclonal, Humanized (therapeutic use)
• Aorta (surgery)
• Aortitis (complications, diagnosis, drug therapy, surgery)
• Humans
• Interleukin-6 (immunology)
• Male
• Middle Aged
• Polymyalgia Rheumatica (complications, diagnosis, drug therapy)
• Tomography, X-Ray Computed
• Treatment Outcome