Faculty of Medicine

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    Rituximab in treatment of a patient with granulomatosis with polyangitis - a case report
    (Македонско лекарско друштво = Macedonian medical association, 2023-01)
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    Guchev, Filip
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    Antova, Dubravka
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    Karadzova Stojanovska, Anzhelika
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    Vidinikj, Sonja
    ANCA-associated vasculitis (AAV) is a necrotizing vasculitis with few or no immune deposits that can affect predominantly small vessels. It can affect vessels in every organ and tissue of the body; the clinical manifestations of the disease are extremely variable. B-cells are of major importance in the disease pathogenesis as precursors of ANCA-producing plasma cells and, possibly, also as antigen-presenting and cytokineproducing cells. Therefore, rituximab, a monoclonal antibody drug causing partial B-cell depletion, has emerged as a powerful option in the treatment of AAV such as granulomatosis with polyangiitis. We present the case of a 25-year-old female diagnosed with granulomatosis with polyangiitis and treated with rituximab and high-dose corticosteroids.
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    A complicated case of granulomatosis with polyangiitis
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2025-01)
    Guchev, Filip
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    Vidinikj, Sonja
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    Granulomatosis with polyangiitis, formerly known as Wegener's granulomatosis, is a condition often presenting with granulomatous vasculitis of both the upper and lower respiratory tracts together with glomerulonephritis. Here we present a case of a 17-year-old female patient, who presented with symptoms of pansinusitis with other symptoms gradually following. She was treated with cyclophosphamide which was later switched to rituximab and is now in remission.
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    RITUXIMAB IN TREATMENT OF A PATIENT WITH GRANULOMATOSIS WITH POLYANGIITIS – A CASE REPORT
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-12-15)
    Bojadzioska, Maja
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    Guchev, Filip
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    Antova, Dubravka
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    Karadzova-Stojanoska, Anzhelika
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    Vidinikj, Sonja
    ANCA-associated vasculitis (AAV) is a necrotizing vasculitis with few or no immune deposits that can affect predominantly small vessels. It can affect ve-ssels in every organ and tissue of the body; the clinical manifestations of the disease are extremely variable. B-cells are of major importance in the disease patho¬ge¬nesis as precursors of ANCA-producing plasma cells and, possibly, also as antigen-presenting and cytokine-producing cells. Therefore, rituximab, a monoclonal anti¬body drug causing partial B-cell depletion, has emerged as a powerful option in the treatment of AAV such as granulomatosis with polyangiitis. We present the case of a 25-year-old female diagnosed with granu-lomatosis with polyangiitis and treated with rituximab and high-dose corticosteroids.
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    Severe systemic toxicity after intravenous administration of metamizole and ceftriaxone in a splenectomised patient-case report
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-04)
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    Bekjaroski, Niko
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    Drug-induced toxicity can have a mild to severe clinical presentation as a life-threatening condition. We presented a case with a general vasculitis and severe multi-organ failure in a splenectomised middle-aged woman, which developed after ceftriaxone and metamizole parenteral administration. A middle-aged woman was treated with IV metamizole and ceftriaxone for a fever and soar throat in a local hospital. She had a post traumatic splenectomy 5 years ago. After metamizole, during ceftriaxone administration she felt burning in her face with maculo-papulose rash which started to conflate, spread to whole body and intensively darkened. She was transferred to the University Toxicology Clinic with а hypotension, hypoxemia, generalized necrotic vasculitis with predominant facial distribution. There was increased values for CRP (250 mg/l), WBC (27x10^9/l) and LDH (1867 U/l) during hospitalisation. She also presented anaemia (Er 2.6x10^12/l, Hgb 88 g/l, Hct 0.24), polyserositis-ascites, pleural effusion and mild pericarditis (high sensitive troponin 107 ng/l), acute pancreatitis (amylase 1048 U/l, lipase 881 U/l), hepatomegaly, acute kidney injury (BUN 36.5 mmol/l, creatinine 528 μmol/l, oliguria), disseminated intravascular coagulation (Plt 23x10^9/l, DD 7658ng/ml, PT 56 sec, aPTT 120 sec), vitreous haemorrhage of the right eye and rhabdomyolysis, CPK 428U/l. Microbiological findings were negative. Immunoserology showed positive p-ANCA. The acute renal failure, ascites and pleural effusions resolved under methylprednisolone, meropenem, LMWH, haemodialysis and symptomatic therapy, with normalization of laboratory parameters. A skin biopsy finding was inconclusive. After 25 days, rheumatologist recommended mycophenolate mofetil PO. She was asymptomatic with prednisolone and mycophenolate mofetil therapy during following two years and maintained stable after their discontinuation. Drug-induced toxicity have potential to induce a severe multiorgan failure with life-threatening complications. Splenectomy may be studied as a potentially risk factor for immunomodulated response to drugs and drugs interactions, especially during infections.