Targeting complement dysregulation: eculizumab in scleroderma renal crisis management-a case-based review


TOKER DİNÇER Z., DİNÇER M. T., Sen G., UĞURLU S., SEYAHİ N., SEYAHİ E.

RHEUMATOLOGY INTERNATIONAL, cilt.44, sa.12, ss.3135-3140, 2024 (SCI-Expanded, Scopus) identifier identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 44 Sayı: 12
  • Basım Tarihi: 2024
  • Doi Numarası: 10.1007/s00296-024-05689-z
  • Dergi Adı: RHEUMATOLOGY INTERNATIONAL
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, Veterinary Science Database
  • Sayfa Sayıları: ss.3135-3140
  • Anahtar Kelimeler: Acute kidney injury, Complement system, Systemic sclerosis, Thrombotic microangiopathy
  • İstanbul Üniversitesi-Cerrahpaşa Adresli: Evet

Özet

Systemic sclerosis (SSc) poses significant challenges in clinical management, especially when complicated by scleroderma renal crisis (SRC), a rare but life-threatening manifestation. Here, we report a 41-year-old female patient with SSc who presented with SRC and concurrent thrombotic microangiopathy. Her condition persisted despite conventional treatments such as plasma exchange and renin-angiotensin-aldosterone system blockade. In particular, treatment with eculizumab, a C5 complement inhibitor, led to a rapid improvement in platelet count, reduction in lactate dehydrogenase levels, and complete recovery of renal function. Genetic testing revealed a variant of unknown significance in the thrombomodulin (THBD) gene, which is associated with the complement system. This case highlights the complex interplay between complement dysregulation and SRC, and highlights the promising role of eculizumab in refractory cases. Further investigation of complement involvement and the efficacy of eculizumab in SRC warrants attention to improving therapeutic outcomes in this challenging condition.