rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2023-42-46rsp-3276Research ArticleПРОБЛЕМЫ РЕВМАТОЛОГИИ В ПЕРИОД ПАНДЕМИИ КОРОНОВИРУСНОЙ БОЛЕЗНИ 2019PROBLEMS OF RHEUMATOLOGY DURING THE 2019 CORONAVIRUS PANDEMICCOVID-19 у больной гранулематозом с полиангиитом: вопросы тактики веденияCOVID-19 in a patient with granulomatosis with polyangiitis: Management tacticshttps://orcid.org/0000-0002-9792-7712ИсхаковаЭ. Ф.IskhakovaE. F.

420012, Российская Федерация, Казань, ул. Бутлерова, 49 

Elmira Iskhakova 

420012, Russian Federation, Kazan, Butlerov str., 49

elmiraiskhakova@yandex.ruhttps://orcid.org/0000-0001-6274-4636СухоруковаЕ. В.SukhorukovaE. V.

420064, Российская Федерация, Казань, Оренбургский тракт, 138 

420064, Russian Federation, Kazan, Orenburgskiy tract, 138 

https://orcid.org/0000-0001-5602-5299БадееваМ. Ю.BadeevaM. Yu.

420064, Российская Федерация, Казань, Оренбургский тракт, 138 

420064, Russian Federation, Kazan, Orenburgskiy tract, 138 

https://orcid.org/0000-0003-1366-006XДьяковаЕ. В.DyakovaE. V.

420064, Российская Федерация, Казань, Оренбургский тракт, 138 

420064, Russian Federation, Kazan, Orenburgskiy tract, 138 

https://orcid.org/0000-0001-5474-8565ЛапшинаС. А.LapshinaS. A.

420012, Российская Федерация, Казань, ул. Бутлерова, 49 

420012, Russian Federation, Kazan, Butlerov str., 49

https://orcid.org/0000-0003-2641-9785БекетоваТ. В.BeketovaT. V.

115522, Российская Федерация, Москва, Каширское шоссе, 34а121356, Российская Федерация, Москва, ул. МаршалаТимошенко, 15107023, Российская Федерация, Москва, ул. БольшаяСемёновская, 38 

115522, Russian Federation, Moscow, Kashirskoye Highway, 34A 

121359, Russian Federation, Moscow, Marshala Timoshenko str., 15 

107023, Russian Federation, Moscow, Bolshaya Semyonovskaya str., 38 

https://orcid.org/0000-0001-7069-2725АбдулганиеваД. И.AbdulganievaD. I.

420012, Российская Федерация, Казань, ул. Бутлерова, 49 

420064, Российская Федерация, Казань, Оренбургский тракт, 138 

420012, Russian Federation, Kazan, Butlerov str., 49420064, Russian Federation, Kazan, Orenburgskiy tract, 138 

ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РоссииРоссияKazan State Medical UniversityRussian FederationГАУЗ «Республиканская клиническая больница» Минздрава Республики ТатарстанРоссияRepublican Clinical Hospital of the Ministry of Health of the Republic of TatarstanRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБУ «Центральная клиническая больница с поликлиникой» Управления делами Президента Российской Федерации; ФГАОУ ВО «Московский политехнический университет»РоссияV.A. Nasonova Research Institute of Rheumatology; Central Clinical Hospital of the Administrative Directorate of the President of the Russian Federation; Moscow Polytechnic UniversityRussian FederationФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России; ГАУЗ «Республиканская клиническая больница» Минздрава Республики ТатарстанРоссияKazan State Medical University; Republican Clinical Hospital of the Ministry of Health of the Republic of TatarstanRussian Federation2023020320236114246Copyright © Исхакова Э.Ф., Сухорукова Е.В., Бадеева М.Ю., Дьякова Е.В., Лапшина С.А., Бекетова Т.В., Абдулганиева Д.И., 20232023Исхакова Э.Ф., Сухорукова Е.В., Бадеева М.Ю., Дьякова Е.В., Лапшина С.А., Бекетова Т.В., Абдулганиева Д.И.Iskhakova E.F., Sukhorukova E.V., Badeeva M.Y., Dyakova E.V., Lapshina S.A., Beketova T.V., Abdulganieva D.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3276

Больные системными васкулитами, ассоциированными с антинейтрофильными цитоплазматическими антителами (АНЦА-СВ), вызывают серьезную настороженность в период пандемии новой коронавирусной инфекции (COVID-19, coronavirus disease 2019), что обусловлено многими факторами, включая исходное повреждение барьерных органов (верхние дыхательные пути, легкие) и почек, лечение иммуносупрессантами, трудно прогнозируемое течение COVID-19 с риском обострения АНЦА-СВ. Приводится клиническое наблюдение развития COVID-19 средней степени тяжести у больной гранулематозом с полиангиитом, длительное время получавшей анти-В-клеточную терапию ритуксимабом (РТМ). Коронавирусная пневмония развилась через год после инфузии РТМ на фоне сохраняющейся деплеции В-лимфоцитов. С целью обеспечения адекватного противовирусного иммунного ответа и предупреждения гипервоспаления проводили лечение, включавшее противовирусные препараты, антикоагулянты, антиковидную плазму, человеческий нормальный иммуноглобулин, антагонист интерлейкина 6 тоцилизумаб. Исход заболевания был благоприятным, с регрессом изменений в легких по данным компьютерной томографии. Обсуждаются возможные предикторы тяжелого течения COVID-19 у пациентов с АНЦА-СВ.

Patients with ANCA-associated vasculitis (AAV) cause extreme alertness during the coronavirus disease 2019 (COVID-19) pandemic, associated with many factors: the initial damage to the respiratory system (upper respiratory tract, lungs) and kidneys, immunosuppressive treatments, difficult prognosis of COVID-19 with the risk of AAV exacerbation. We present a clinical case of а moderate COVID-19 in a patient with granulomatosis with polyangiitis, who received anti-B cell therapy with rituximab (RTX) for a long time. Coronavirus pneumonia developed one year after RTX, while B-lymphocyte depletion persisted. In order to achieve an adequate antiviral immune response and prevent hyperinflammation, treatment was carried out with antiviral drugs, anticoagulants, convalescent plasma, human normal immunoglobulin, and interleukin-6 antagonist tocilizumab. Possible predictors of severe COVID-19 in patients with AAV are discussed.

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The authors declare that there are no conflicts of interest present.