Difficult to treat relapsing polychondritis responded to tocilizumab in a teaching hospital in Western Kenya: Case report

Abstract

Relapsing polychondritis is a rare autoimmune condition affecting the cartilaginous areas. Some cases respond poorly to conventional Disease Modifying Antirheumatic Agents (DMARDs) and may need biological agents. Here we present such as a case from a teaching hospital in Kisumu, Kenya. A 35 year old lady presented with a one year history of recurrent ear and nasal inflammation, eye pain and reddening, joint pains and swelling, and skin rash affecting the limbs and the trunk. She had been on treatment over the last one year with steroids, leflunomide, methotrexate and cyclophosphamide without significant improvement. Clinical exam showed: episcleritis, erythema nodusum-like skin rash, inflammation of the pinnae, bilateral ankle arthritis and saddleback deformity of the nose. Her inflammatory markers were elevated. She was started on monthly intravenous tocilizumab at 6mg/ kg and made remarkable improvement. Tocilizumab is an effective therapy for difficult to treat relapsing polychondritis.