1 / 23

Case 1

Case 1. Chart number:20139683 name: 林 XX Occupation: 水電工 Age:55 years old Sex: male. 2009/5/26 Start Humira. 2010/6/01 Stop Humira. Major event. 2010/5/4 OPD :QFT (+) 2010/5/10 Open TB. 2010/10/19 Shift Rituximab. 2008/9/2 Diagnosed RA.

kermit-cameron
Télécharger la présentation

Case 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case 1 • Chart number:20139683 • name: 林XX • Occupation: 水電工 • Age:55 years old • Sex: male

  2. 2009/5/26 Start Humira 2010/6/01 Stop Humira Major event 2010/5/4 OPD :QFT (+) 2010/5/10 Open TB 2010/10/19 Shift Rituximab 2008/9/2 Diagnosed RA

  3. 2008/9/2: diagnosed RA with DAS-28:8.3 • Start MTX 10mg QW ,HCQ 200mg QD( from 9/2) ,Leflunomide 20mg QD and prednisolone 5mg QD (from 11/11) back

  4. DAS 28 Humira Rituximab DC Humira due to TB

  5. back • 2009/5/26 • PPD negative • Quantiferon test negative • CXR no active lesion • Start Adalimumab due to high RA disease activity under DMARDs(DAS 28:5.53)

  6. DAS 28 Humira Rituximab DC Humira due to TB

  7. Return rheuma OPD on 5/4 • QFT follow-up (+) • Lack of AFB result due to no productive cough • CXR suspected pulmonary TB • Start INH 300mg QD

  8. 2010/5/10: admitted to chest ward due to prolonged fever one week and productive cough • Sputum AFB positive • Diagnosed : pulmonary miliary TB • Stop Humira • Treated with Rifater + EMB back

  9. DAS 28 back Humira Rituximab DC Humira due to TB

  10. DAS 28 Humira Rituximab DC Humira due to TB

  11. Return chest OPD 2010/7/27 • Sputum culture :M. tuberculosis complex sensitive to all anti-TB medications • Discontinue EMB since 2010/9/21 • Complete 9 months TB treatment on 2011/2/15

  12. Case 2 • Chart number:2453132 • name: 陳XX • Occupation: housekeeper • Age:52 • Sex: female

  13. 2008 /3 Enbrel 2000-2006 treat with DMARs 2006/10 Add Leflunomide 2009/10 Abnormal LFT Stop Enbrel Start ETV 2007/12 Change ETV Major event 2006/12 Abnormal LFT 2007/3 DC MTX and Leflunomide Start LMV 2010/9 Resume Enbrel 2008/8 Stop ETV 2000 diagnosed RA

  14. Present illness • Past history with hepatitis B carrier • Diagnosed with rheumatoid arthritis from 2000 • 2000-2004 • Treated with NSAID ,HCQ and prednisolone 5mg QD • Added MTX (15mg QW) from 2004/11/3 • Add Leflunomide 10mg QD from 2006/10/7 back

  15. ALT and total bilirubin DC Enbrel Add ETV Complete ETV Enbrel 2007/2 HBV-DNA 5.61 Mcps 2007/8 HBV-DNA <0.00035Mcps 2008/7 HBV-DNA Non-detectable 2009/3 HBV-DNA 0.119Mcps

  16. DAS 28 DC Enbrel Enbrel Resume Enbrel

  17. Case 3 • Chart number:20020457 • name: 林XX • Occupation: 機車修理退休 • Age:69 • Sex: male

  18. 2004/8/29 Start Enbrel 2011/1/13 lymphoma Major event 2006/9/19 Stop Enbrel 2000/7/17 Diagnosed RA

  19. 2000/7/17 : diagnosed with Rheumatoid arthritis • Start MTX 7.5 mg QW and Sulfasalazine 500mg BID back

  20. back DAS 28 DC Enbrel

  21. 2006/9/9 admission • Stop Enbrel and MTX on due to pancytopenia • 2006/9/7 Abdominal echo • Fatty liver and splenomegaly • Consider Felty’s syndrome

  22. back DAS 28 DC Enbrel

  23. 2011/1/13 : Prolonged fever for one month • Right neck lymph node biopsy • Nodular sclerosis classical Hodgkin lymphoma • DAS28:2.79 • Treat lymphoma with 8 cycles ABVD on 2011/3/10 - 2011/10/20 (Doxorubicine ,Bleomycin, Vinblastin, and Dacarbazine)

More Related