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We describe a patient with polymyalgia rheumatica/giant cell arteritis (PMR/GCA) whose disease was refractory to a reduction in the dose of her glucocorticoid to an acceptable level. Our patient improved after B lymphocyte depletion but developed respiratory problems. To our knowledge this is the first description of such a case.
An 82 year old woman presented with a 4 week history of symptoms consistent with GCA of the temporal arteries and PMR. Of significance in her past medical history she had significant chronic airflow limitation with an FEV1/FVC (forced expiratory volume in 1 second/forced vital capacity) of 0.7/1.2. Computed tomography of her chest identified a small area of bronchiectasis in the left lower lobe of her chest.
Her erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were, 109 mm/1st h (normal 1–20) and 230 mg/l (normal 0–5.0), respectively. Treatment was started with 50 mg of prednisolone. Three weeks later …
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