Aseptic Abscess Syndrome in Rheumatoid Arthritis Patient

Abstract

Aseptic abscess syndrome (AAS) is a rare, potentially life-threatening disorder, with numerous features of neutrophilic dermatoses. The main symptoms include aseptic abscess-like collections in internal organs (spleen, liver, lungs), lack of microbes (bacteria, viruses, or parasites) after an exhaustive search, ineffectiveness of antibiotics, and high sensitivity to corticosteroid therapy. AAS is characterized by the development of deep, inflammatory abscesses and systemic symptoms (weight loss, abdominal pain, fever, and leukocytosis). They may be associated with inflammatory bowel disease (IBD) and autoimmune diseases. The patient in this study is a 67-year-old man, suffering from rheumatoid arthritis (RA), with numerous purulent abscesses in the mediastinum, within the subcutaneous tissue above the extension surfaces of the joints, and on the dorsum of the hands. The lesions are accompanied by bone destruction. The patient was treated with prednisone 40 mg and adalimumab, which resulted in a quick reduction of inflammatory markers and clinical improvement, as well as the healing and absorption of abscesses. Despite COVID-19 infection, treatment with remdesivir, prednisone, and adalimumab was continued, with the complete resolution of the lesions. AAS is difficult to recognize, so practitioners have to be aware of this condition, especially in patients with RA.

Aseptic Liver Abscess in a Patient With Diversion Colitis

“…However, previous studies have linked AAS with intestinal inflammation, particularly in the context of IBD and other autoinflammatory conditions. [1][2][3][4][5][6][7][8] A pervious case report suggested a potential link between AAS and traveler's diarrhea, although in that case, the liver lesions resolved only with heavy immunosuppression, indicating a probable predominant autoinflammatory mechanism in abscess formation. 9 In cases where AAS presented in patients with IBD, favorable responses to immunosuppression and long-term remission with steroid-sparing agents have been observed.…”

“…3,10 Our patient exhibited clinical, endoscopic, and histologic signs of active severe diversion colitis. 8 The pathogenesis of diversion colitis remains uncertain, with proposed mechanisms including deficiencies in short-chain fatty acids or other luminal nutrients, alterations in the colonic microbiome, and changes in mucosal immunity. 11,12 Interestingly, previous case reports showed that diversion colitis may progress into a symptomatic ulcerative colitis-like condition in the diverted colon.…”

“…However, previous studies have linked AAS with intestinal inflammation, particularly in the context of IBD and other autoinflammatory conditions. 1–8…”

Aseptic pyomyositis in rheumatoid arthritis treated with corticosteroid and DMARDs

“…The main characteristics of aseptic pyomyositis include absence of microbes, bacteria, viruses, and parasites; and poor response to antibiotic therapy [ 1 ]. Rapid clinical improvement after corticosteroid therapy (with colchicine and DMARDs- Disease Modifying Anti-Rheumatic Drugs) is an important feature [ 1 , 2 ]. It is usually associated with autoimmune inflammatory diseases like rheumatoid arthritis (RA), lupus, inflammatory bowel disease [ 2 ].…”

Immune-Mediated Skin Diseases: Future Therapeutic Perspectives

“…However, the association with a steroid-sparing immunomodulator is suggested, considering that longer-term treatments may be required: adalimumab therapy was added in this case at a dose of 80 mg subcutaneously followed by 40 mg every two weeks. Finally, the authors reported that adalimumab therapy was continued even when the patient received remdesivir, following symptomatic SARS-CoV-2 infection without complications [6].…”