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Case Reports
. 2018 Dec 6:2018:2856546.
doi: 10.1155/2018/2856546. eCollection 2018.

Clinical Utility of Neutrophil CD64 to Detect Extrapulmonary Tuberculosis in Three Patients with Rheumatoid Arthritis Undergoing Treatment with Biologics

Shinichi Nogi  1 , Yoshiyuki Arinuma  2 , Akiko Komiya  3 , Atsushi Hashimoto  1 , Toshihiro Matsui  1 , Shigeto Tohma  4
Affiliations
Case Reports

Clinical Utility of Neutrophil CD64 to Detect Extrapulmonary Tuberculosis in Three Patients with Rheumatoid Arthritis Undergoing Treatment with Biologics

Shinichi Nogi et al. Case Rep Rheumatol. .

Abstract

Biologics play a key role in the treatment of rheumatoid arthritis (RA), while RA-related serious infection remains an unsettled clinical problem. Detection of tuberculosis (TB) is challenging due to the difficulty in distinguishing symptoms such as fever and elevation of inflammatory markers from other infections or a disease flare of RA. The expression of the CD64 molecule on neutrophils (neutrophil CD64) was upregulated by various infections including TB. However, it was not affected by disease activity of RA or by any therapy against RA. The present article reports three cases of extrapulmonary TB which occurred in patients with RA undergoing treatment with biologics. The marked increase in the levels of neutrophil CD64 may provide important insight into the diagnosis of TB.

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Figures

Figure 1
Figure 1
Levels of neutrophil CD64 elevated with dissociation of a CRP change (case 1). The cutoff value for the levels of neutrophil CD64 was 2000 molecules/cell.
Figure 2
Figure 2
Computed tomography scan images of case 1. Particulate lesions diffusely observed in both lung fields (a) were diminished after antituberculosis therapy (b); cystic lesion with the same absorption range as abscess observed in paraspinal muscle (c) was also diminished after antituberculosis therapy (d).
Figure 3
Figure 3
Levels of neutrophil CD64 increased even after antibiotic therapy (case 2).
Figure 4
Figure 4
(a) Chest CT scan image at the time of admission. Diffuse particulate shadows are shown in the whole-lung field at random; (b) noncaseating epithelioid granuloma was observed in bronchial and alveolar specimens obtained through bronchoscopy (hematoxylin and eosin (H & E) stain; magnification x400); (c) a cellulitis-like lesion on the patient's right lower limb; (d) biopsy specimens from cellulitis also revealed erythema induratum of Bazin (H & E stain; magnification x400) (case 2).
Figure 5
Figure 5
High levels of neutrophil CD64 were maintained since admission to the hospital (case 3).
Figure 6
Figure 6
(a, b) Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging of the brain revealed pia-subarachnoid enhancement (case 3).
See this image and copyright information in PMC

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