Efficacy of tocilizumab for interstitial lung disease in an undifferentiated autoinflammatory disorder partially responsive to anakinra

摘要

Sir, A 15-year-old Caucasian girl with obsessive compulsive disorder (OCD) was referred to Paediatric Rheumatology in 2006, housebound with a 4-year history of exertional dyspnoea requiring home oxygen and small-volume haemoptysis. Other symptoms included episodic fever, severe oropharyngeal ulceration, diarrhoea, large joint arthritis and urticarial vasculitic rash. She was ame-norrhoeic. There was no relevant family history; she was a non-smoker and denied substance abuse. Examination revealed oxygen saturations of 84% with desaturation to 61% post-exercise. There was microcytic anaemia and elevated inflammatory markers on blood testing: haemoglobin 7.7 g/dl (normal range 12.0-15.0 g/dl), mean cell volume 67 fl (83-105 fl), CRP 97mg/l (0-5 mg/l) and ESR 44 mm/h (5-15 mm/h).