Abstract |
Amegakaryocytic thrombocytopenia is an extremely rare disorder in systemic lupus erythematosus, and its mechanism and treatment are still largely unknown. We describe a 42-year-old woman with systemic lupus erythematosus who presented various clinical manifestations of life-threatening amegakaryocytic thrombocytopenia (10,000 platelets/mm3 with a marked decrease of megakaryocytes in the bone marrow), proteinuria, psychosis, refractory chylothorax, ascites, and type II diabetes caused by the anti- insulin receptor autoantibody. She was initially treated with prednisolone (25-50 mg/day) and cyclosporine A (200 mg/day) without any improvement in severe thrombocytopenia. However, her clinical symptoms, including platelet counts, dramatically improved, with a concurrent decrease in the anti-c-Mpl antibody, an autoantibody against the thrombopoietin receptor, after a subsequent treatment with rituximab (375 mg/m2 intravenously, weekly, for two consecutive weeks). Our case suggested that amegakaryocytic thrombocytopenia in patients with systemic lupus erythematosus might be mediated by the anti-c-Mpl antibody and could be treated with rituximab through elimination of pathogenic B cells producing autoimmune antibodies.
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Authors | T Fukushima, L Dong, T Sakai, T Sawaki, M Miki, M Tanaka, Y Masaki, Y Hirose, M Kuwana, H Umehara |
Journal | Lupus
(Lupus)
Vol. 17
Issue 3
Pg. 210-4
(Mar 2008)
ISSN: 0961-2033 [Print] England |
PMID | 18372362
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD20
- Autoantibodies
- Receptors, Thrombopoietin
- MPL protein, human
- Rituximab
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Topics |
- Adult
- Antibodies, Monoclonal
(therapeutic use)
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD20
(immunology)
- Autoantibodies
(blood)
- Blood Platelets
(immunology)
- Female
- Humans
- Lupus Erythematosus, Systemic
(complications, immunology)
- Megakaryocytes
(pathology)
- Receptors, Thrombopoietin
(immunology)
- Rituximab
- Thrombocytopenia
(drug therapy, etiology)
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