Tocilizumab as a Potential Alternative Therapy for Acute Exacerbation of Systemic Sclerosis-Associated Interstitial Lung Disease in a Dialysis Patient Following Immunodeficiency-Associated Lymphoproliferative Disorders

A 62-year-old woman was diagnosed with diffuse cutaneous systemic sclerosis (dcSSc), complicated by scleroderma renal crisis, resulting in maintenance dialysis. Mycophenolate mofetil (MMF) and low-dose prednisolone stabilized her interstitial lung disease (ILD). Five years after the dcSSc diagnosis, she developed brain immunodeficiency‑associated lymphoproliferative disorders. Consequently, MMF was discontinued. Three months after MMF cessation, she developed a cough and productive sputum. Imaging revealed new ground-glass opacities (GGOs) in both lungs, indicating an acute exacerbation of systemic sclerosis-associated ILD (SSc-ILD). Tocilizumab was started, resulting in the rapid resolution of symptoms and new GGOs. Although this is a single case report, the findings suggest that tocilizumab may be a viable therapeutic option for SSc-ILD exacerbation, particularly in patients with limited treatment choices due to complex comorbidities.