Case report
Ciprofloxacin, doxycycline and anakinra in the treatment of Schnitzler syndrome
Alemka Markotić
; Klinika za infektivne bolesti "Dr. Fran Mihaljevć", Zagreb
Višnja Škerk
; Klinika za infektivne bolesti "Dr. Fran Mihaljevć", Zagreb
Abstract
Schnitzler syndrome describes the simultaneous occurrence of monoclonal gammopathy and chronic urticaria as major symptoms with at least two additional minor symptoms (arthralgia, arthritis, fever of unknown origin, hepato- or splenomegaly, lymphadenopathy, increased erythrocyte sedimentation rate, leukocytosis/thrombocytosis or increased bone density). The etiology and immunopathogenesis of disease is unknown, but increased levels of interleukine (IL)-1 have been detected in some patients. The most successful therapy was recorded with anakinra, recombinant, nonglycosylated form of the human interleukin-1 receptor antagonist (IL-1RA). Here we describe a female patient with Schnitzler syndrome who was initially treated for three years with a combination of ciprofloxacin and doxycycline, followed by anakinra. Partial remission in terms of significant regression of the rash, reduced arthritis and occasional subfebrility was recorded during the three-year per os combination treatment with 2 × 500 mg ciprofloxacin, 2 × 100 mg doxycycline and 1 × 5 mg desloratadine. Any interruption of this therapy would result in a prompt appearance of severe urticaria, fever, and worsening of the findings (elevated ESR and CRP, leukocytosis and neutrophilia). This successful control of the symptoms and findings was attributed to a synergistic effect of ciprofloxacin and doxycycline and their probable immunomodulatory role in lowering the levels of proinflammatory cytokines, including IL-1. A significant improvement, however, was recorded in our patient after anakinra administration. During the two-year treatment, apart from transient, mild hepatic lesions, no side effects or symptoms have been reported, and laboratory findings were within normal range.
Keywords
Schnitzler syndrome; anakinra; ciprofloxacin; doxycycline
Hrčak ID:
66769
URI
Publication date:
31.3.2011.
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