Open AccessINFECTIOUS COMPLICATIONS IN A PATIENT WITH SYSTEMIC SCLERODERMA AND MULTIPLE ORGAN DYSFUNCTION: A CASE REPORT
Author(s) -
В. М. Ждан,
Ye. M. Kіtura,
Марина Юріївна Бабаніна,
O.V. Gordiienko,
T.V. Moroz
Publication year - 2020
Publication title -
aktualʹnì problemi sučasnoï medicini: vìsnik ukraïnsʹkoï medičnoï stomatologìčnoï akademì
Language(s) - English
Resource type - Journals
eISSN - 2077-1126
pISSN - 2077-1096
DOI - 10.31718/2077-1096.20.1.222
Subject(s) - medicine , systemic scleroderma , rheumatoid arthritis , scleroderma (fungus) , pathology , systemic disease , connective tissue disease , sepsis , polyarthritis , arthritis , infectious arthritis , dermatology , fibrosis , serositis , myocarditis , dermatomyositis , disease , immunology , autoimmune disease , inoculation
Systemic scleroderma is an autoimmune connective tissue disease with characteristic lesions of the skin, blood vessels, musculoskeletal system and internal organs (kidneys, heart, lungs, and digestive tract) based on impaired microcirculation, inflammation and generalized fibrosis. At the stage of provisional diagnosis, the triad of the initial signs of the disease is especially important including Raynaud’s syndrome, characteristic skin lesions, and joint syndrome. Subsequently, multiple organs and tissues are involved in the process. Infectious complications are one of the major threats to patients with systemic connective tissue disease, along with cardiovascular and cancerous diseases. Based on retrospective analysis, it has been found out that the incidence of comorbid infections in the in-patients with rheumatic diseases made up 9.7%; with predominant damage to respiratory organs was 44%, urinary tract – 29.2%, and skin and soft tissues – 18.9%. Comorbid infections were the most common in patients with systemic lupus erythematosus (28.4%) and rheumatoid arthritis (13.2%). Infections constitute 2-9% of overall causes of mortality in patients with systemic scleroderma. Cases of serious infections (pneumonia, sepsis, bacterial arthritis, skin and soft tissues lesions, etc.) have been recorded, including those with fatal outcomes. The problem of differential diagnosis of systemic infectious process and rheumatic diseases with high activity is extremely important. The paper presents a clinical case of subacute course of systemic scleroderma with multiple organ dysfunction affecting lungs (pneumofibrosis, pulmonary hypertension), heart (restrictive cardiomyopathy, atrial flutter), kidneys (nephritis) conjoined with severe infectious complications (septicemia, phlegmon of the soft tissues of the left leg). The present clinical case clearly demonstrates a severe subacute course with multiple organ dysfunction affecting lungs, heart, kidneys, digestive tract. Immunodeficiency was accompanied by severe infectious complications, in particularly, septicemia, soft tissue phlegmon, having complex pathogenesis that required prolonged intensive care.