A case of Evans syndrome combined with systemic lupus erythematosus successfully treated with rituximab

Evans syndrome is a rare autoimmune disorder with unknown aetiology. Although corticosteroids and or intravenous immunoglobulin (IVIG) are commonly used in its treatment, no standard strategy has been established. We report here a 44-year-old male with refractory Evans syndrome combined with systemi...

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Veröffentlicht in:Scandinavian journal of rheumatology 2008-01, Vol.37 (5), p.390-393
Hauptverfasser: Kittaka, K., Dobashi, H., Baba, N., Iseki, K., Kameda, T., Susaki, K., Kitanaka, A., Kubota, Y., Ishida, T.
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Sprache:eng
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Zusammenfassung:Evans syndrome is a rare autoimmune disorder with unknown aetiology. Although corticosteroids and or intravenous immunoglobulin (IVIG) are commonly used in its treatment, no standard strategy has been established. We report here a 44-year-old male with refractory Evans syndrome combined with systemic lupus erythematosus (SLE) who responded well to rituximab. He was admitted to our hospital with severe bleeding caused by worsening of Evans syndrome. Despite treatment with a high-dose corticosteroid and IVIG, his thrombocytopaenia and haemolytic anaemia did not improve. We started rituximab at a dose of 375 mg m2 once a week for a total of two doses. There was significant improvement in his thrombocytopaenia and anaemia 1 month after administration of rituximab. Although the total immunoglobulin G (IgG) level did not change, the titres of platelet-associated IgG (PA-IgG) and of an indirect antiglobulin test (IAT) decreased under the treatment with rituximab. It is suggested that rituximab would be a powerful candidate in the treatment of refractory Evans syndrome by depleting abnormal clone-producing autoantibody.
ISSN:0300-9742
1502-7732
DOI:10.1080/03009740802068599