We describe two female patients with
systemic lupus erythematosus (SLE) who developed severe
aplastic anemia. Although each patient had received multiple medications including
diphenylhydantoin, the relationship to these drugs to the development of marrow aplasia was unclear. After administration of an oral
androgen (
oxymethalone) and
corticosteroids, there was complete hematologic recovery. Both patients relapsed when
oxymethalone was withdrawn, and both recovered when
androgen therapy was reinstituted, with or without high-dose
prednisone. In both patients, there was complete reversal of
pancytopenia despite the presence of initially severe marrow aplasia (less than 10% cellularity). However, in both cases, prolonged
androgen therapy (2 months) was required before hematologic improvement occurred.
Androgens are known to stimulate hematopoiesis in man, and they appear to influence immune function in a mouse model of SLE. Thus
androgens may be particularly useful in the treatment of SLE-associated
aplastic anemia.