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№3 (33) 2014 CLINICAL MEDICINE OF KAZAKHSTAN
КЛИНИКАЛЫҚ ЖАҒДАЙ/КЛИНИЧЕСКИЙ СЛУЧАЙ/CASE REPORT
Материал поступил в редакцию: 20-09-2014 Материал принят к печати: 15-10-2014 УДК: 616-002.77
A case of systemic lupus erythematosus presented with autoimmune hemolytic anemia: treated successfully with cyclosporine
Recep Tunc* 1, Ilknur Albayrak2, Abdulkadir Basturk3, Sevket Arslan1, Adem Kucuk1
1Necmettin Erbakan University, Konya, Turkey
2Selcuk University, Konya, Turkey
3Konya Education and Research Hospital, Konya, Turkey
Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disorder, hematological derangements in SLE are widely recognized, with lymphopenia being the most common although anemia and thrombocytopenia are also seen.
Key words: systemic lupus erythematosus, hemolytic anemia, cyclosporine
J Clin Med Kaz 2014; 3(33): 32-33.
Address correspondence to: Adem Kucuk, MD. Division of Rheumatology, Department of Internal Medicine, Meram School of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey. Email: [email protected], Tel: +903322237516, Fax: +903323243982
АУТОИММУНДЫ ГЕМОЛИТИКАЛЫҚ АНЕМИЯМЕН БІРГЕ КЕЗДЕСКЕН ЖҮИЕЛІ ҚЫЗЫЛ ЖЕГТНТҢ КЛИНИКАЛЫҚ ЖАҒДАИЫ: ЦИКЛОСПОРИНМЕН нәтижелі емдеу
Recep Tunc1, Ilknur Albayrak2, Abdulkadir Basturk3, Sevket Arslan1, Adem Kucuk1
1 Неджметтин Эрбакан университеті, Кония, Tүркия
2 Сельчук университеті, Кония, Tүркия
3 ^ния білім мен ғылым ауруханасы, Кония, Түркия
Жүйелі қызыл жегі (ЖҚЖ) - жүйелі аутоиммунды ауру. Гемолитикалық анемия, лейкопения, лимфопения, тромбоцитопения ЖҚЖ кезінде жиі кездесетін гематологиялық проблемалар болып табылады. Мақалада әлсіздікке шағымдалған 19 жастағы қыз баланың клиникалық жағдайы сипатталған. Біз аутоиммунды гемолитикалық анемияның циклоспориннің көмегімен оң нәтижелі емделуі тәжірибесін ұсынып отырмыз. Маңызды сөздер: жүйелі қызыл жегі, гемолитикалық анемия, циклоспорин.
КЛИНИЧЕСКИЙ СЛУЧАИ СИСТЕМНОЙ КРАСНОЙ волчанки С АУТОИММУННОЙ ГЕМОЛИТИЧЕСКОЙ АНЕМИЕЙ: УСПЕШНОЕ ЛЕЧЕНИЕ ЦИКЛОСПОРИНОМ
Recep Tunc1, Ilknur Albayrak2, Abdulkadir Basturk3, Sevket Arslan1, Adem Kucuk1
1 Университет Неджметтин Эрбакан, Конья, Турция
2 Университет Сельчук, Конья, Турция
3 Больница образования и науки Коньи, Конья, Турция
Системная красная волчанка (СКВ) - это системное аутоиммунное заболевание. Гемолитическая анемия, лейкопения, лимфопения, тромбоцитопения являются наиболее распространенными гематологическими проблемами при СКВ. В статье описан клинический случай 19-летней молодой девушки с жалобами на слабость. Мы представляем случай успешнего лечения аутоиммунной гемолитической анемии циклоспорином.
Ключевые слова: системная красная волчанка, гемолитическая анемия, циклоспорин.
INTRODUCTION
Systemic lupus erythematosus (SLE), is a systemic autoimmune disease. In 1997 ACR classification criteria set
autoimmune hemolytic anemia, leukopenia, lymphopenia and thrombocytopenia are recorded [1]. A 19-year-old
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НАУЧНО-ПРАКТИЧЕСКИЙ МЕДИЦИНСКИЙ ЖУРНАЛ
woman was admitted with complaints of weakness. She had autoimmune hemolytic anemia and treated successfully
CASE
19 year-old woman, was admitted with complaints of fatigue and occasional joint pain. Malar rash, photosensitivity and arthritis were not present. 1 year ago she was hospitalized because of anemia, however, at that time, she was undiagnosed. In her family, there was no rheumatic diseases. In physical examination of the patient her face and conjunctiva were pale. Blood pressure was 90/60 mmHg, pulse was 110/min, and fever was 36.7 °С. In laboratory: Sedimentation 19 mm/h, C-reactive protein 58.1 mg/L, WBC 1.3x103, Hgb 6 g/dL, PLT 269x103, creatinin
0.5 mg/dL, ALT 6 U/L, LDH 441 U/L, TSH 2.7, urinalysis was normal. Salmonella and Brucella were negative. Atypical cell was not observed in peripheral blood smear.
DISCUSSION
Most often, SLE starts in people in their 20s and 30s. It occurs 10 times more often in women than in men. A variety of disease manifestations are exhibited by SLE patients, common manifestations include arthritis, pleuritis, nephritis, neuropsychiatric disorders, and hematological disorders. Antierythrocyte antibodies are implicated in the pathogenesis of autoimmune hemolytic anemia. Hemato-
with cyclosporine therapy.
ANA antibody profile was homogeneous and showed a granular staining pattern. Anti- dsDNA and anti-Sm were positive. Direct Coombs was positive. SLE was diagnosed and the patient was given methylprednisolone pulse therapy for 3 days. After then 1 mg/kg dose was maintained. During the follow-up because of fever she diagnosed febrile neutropenia and treated with antibiotic therapy. In addition to steroid medication, hydroxychloroquine 200 mg 2x1 and cyclosporine 100 mg 3x1 were given. The patient’s white blood cell and hemoglobin level rose quickly. Hemoglobin level increased to 13.5 g/dL. The patient’s clinical symptoms were improved.
logical derangements in SLE are widely recognized, with lymphopenia being the most common although anemia and thrombocytopenia are also seen. Autoimmune hemolytic anemia occurs in about 5%-10% of SLE patients [2]. Autoimmune hemolytic anemia in SLE has been treated successfully with steroid and cyclosporine.
REFERENCES
1. Tan EM, Cohen AS, Fries JF. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25:1271-7.
2. Kao AH, Manzi S, Ramsey-Goldman R. Review of ACR hematologic criteria in systemic lupus erythematosus. Lupus 2004; 13: 865-868.
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