托珠单抗诱导的大动脉炎炎症发作：一例病例报告，探讨Fcγ受体参与的机制
Tocilizumab-induced inflammatory flare in Takayasu arteritis: a case report with exploratory mechanistic findings of Fcγ receptor involvement.
摘要(中文译文)
报告一例难治性大动脉炎（TAK）患者在接受托珠单抗（TCZ）治疗后出现严重炎症 flare，并探讨其潜在机制。一名21岁女性活动性TAK患者在对泼尼松反应不足后接受TCZ治疗。因疾病复发，TCZ被暂时停用后以400 mg重新加用。重新引入TCZ后，患者出现血管疼痛加重、新发腹痛、头晕、发热及炎症标志物显著升高。影像学显示动脉炎加重及新发肠系膜上动脉炎。甲泼尼龙冲击治疗及英夫利西单抗未能控制 flare，但托法替布在一个月内实现症状完全缓解及炎症标志物正常化。采集患者外周血样本，评估TCZ刺激后外周血单个核细胞（PBMCs）Fcγ受体（FcγR）表达及下游信号传导。研究显示，随着TCZ浓度增加，患者PBMCs中FcγRIIA、FcγRIIB和FcγRI表达增强，同时脾酪氨酸激酶（SYK）磷酸化增加。TCZ可矛盾性地触发难治性TAK的炎症 flare，探索性证据提示可能涉及过度FcγR激活。非抗体类Janus激酶（JAK）抑制剂如托法替布可能作为此类病例的有效挽救治疗。
Abstract
To report a refractory Takayasu arteritis (TAK) patient who developed a severe inflammatory flare after tocilizumab (TCZ) therapy and explore the underlying mechanism. A 21-year-old female with active TAK received TCZ after insufficient response to prednisone. TCZ was temporarily withheld then re-added at 400 mg due to disease relapse. After TCZ reintroduction, the patient developed worsening vascular pain, new abdominal pain, dizziness, fever, and markedly elevated inflammatory markers. Imaging showed worsened arteritis and new superior mesenteric arteritis. Methylprednisolone pulse and infliximab failed to control the flare, but tofacitinib achieved complete symptom resolution and normalized inflammatory markers within one month. Peripheral blood samples of the patient were collected and peripheral blood mononuclear cells (PBMCs) Fcγ receptor (FcγR) expression and downstream signaling were assessed upon TCZ stimulation. studies showed that increasing TCZ concentrations were associated with enhanced FcγRIIA, FcγRIIB, and FcγRI expression, along with increased spleen tyrosine kinase (SYK) phosphorylation in the patient's PBMCs. TCZ can paradoxically trigger an inflammatory flare in refractory TAK, with exploratory evidence suggesting possible involvement of excessive FcγR activation. Non-antibody-based Janus kinase (JAK) inhibitors like tofacitinib may be effective rescue therapy in such cases.
如何引用
AMA
Ning Shen, Xuexiao Jin, Panpan Lv, Xiaoping Chen, Xiayan Xu, Linrong Lu, et al. Tocilizumab-induced inflammatory flare in Takayasu arteritis: a case report with exploratory mechanistic findings of Fcγ receptor involvement.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1898851.
APA
Ning Shen, Xuexiao Jin, Panpan Lv, Xiaoping Chen, Xiayan Xu, Linrong Lu, et al (2026). Tocilizumab-induced inflammatory flare in Takayasu arteritis: a case report with exploratory mechanistic findings of Fcγ receptor involvement.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1898851
GB/T 7714
Ning Shen, Xuexiao Jin, Panpan Lv, Xiaoping Chen, Xiayan Xu, Linrong Lu, et al. Tocilizumab-induced inflammatory flare in Takayasu arteritis: a case report with exploratory mechanistic findings of Fcγ receptor involvement.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1898851.
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