РЕВМАТОИДНЫЙ АРТРИТ И ЛЕЙКОЗ ИЗ БОЛЬШИХ ГРАНУЛЯРНЫХ Т-ЛИМФОЦИТОВ: ОПИСАНИЕ КЛИНИЧЕСКОГО СЛУЧАЯ

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting the musculoskeletal system. Neutropenia often develops in RA, the pathogenesis of which is currently insufficiently studied. One of the causes of severe neutropenia may be a hematological disease, namely T-cell large granular lymphocyte leukemia (LGL). A third of patients with RA are also diagnosed with LGL, which is due to a similar pathogenetic mechanism. The clinical picture is very diverse and insufficiently specific, which causes difficulties in making a diagnosis. The purpose of this work was to analyze the features of the management of a patient with rheumatoid arthritis combined with T-cell leukemia from large granular cells. A patient born in 1953 with a long history of RA without special treatment was hospitalized in the hematology department with complaints of severe weakness, manifestations of hemorrhagic syndrome. The general blood test revealed severe anemia, leukopenia with agranulocytosis and thrombocytopenia. The patient underwent additional instrumental examinations. Substitution therapy was performed with a positive effect. In this case, peripheral blood immunophenotyping was not performed and the diagnosis was based on trepanobiopsy. According to the immunohistochemical study, leukemia from large granular T-lymphocytes was diagnosed, and therefore the patient receives treatment according to national clinical guidelines. Diagnosis of T-LGL is an urgent issue due to the frequent combination with RA, which indicates the need for a thorough differential diagnosis of neutropenia in this category of patients.