A 61 year old woman was admitted to our hospital suffering from severe
pancytopenia. Bone marrow aspiration revealed marked hypoplasia with 24.8% plasma cells. There was a small amount of
IgA type M
protein in serum.
Multiple myeloma was ruled out on the basis that 1) the amount of serum
IgA-M
protein was minimal and no increase was observed, 2) no indication of monoclonality of bone marrow plasma cells was shown by immunofluorescent staining of
immunoglobulins, 3) neither bone lesion nor other symptoms related to
multiple myeloma were observed. Therefore, a diagnosis of
aplastic anemia was made, and bolus
methylprednisolone therapy (1,000 mg/day x 3 days) was performed, which brought the patient to complete remission. An oral dose of 15 mg of
prednisolone is administered daily now and the remission state is being maintained. Bolus
methylprednisolone therapy is performed quite often for the treatment of
aplastic anemia. However, there are few reports in which remission was reached with the use of
glucocorticoids alone, most having used
androgens or other supportive drugs in conjunction. Here, we will discuss this case of
aplastic anemia which responded to repeated bolus
methylprednisolone therapy, with minimal side effects, and discuss its effectiveness. In addition,
aplastic anemia associated with idiopathic
monoclonal gammopathy is not reported, so this case is interesting immunologically.