title: [Successful treatment of intravenous cyclophosphamide pulse therapy for systemic lupus erythematosus complicated with steroid-resistant hemolytic anemia].
abstract: (Case 1) A 13-years-old female had multiple arthralgia and butterfly rush, when she admitted in our hospital in May 2001. Nephropathy, hemolytic anemia (Hb 6.3 g/dl and direct Coombs 3+) and high titers of antinuclear antibodies and anti-ds-DNA antibody were disclosed and she was diagnosed as systemic lupus erythematosus (SLE). Although combination therapy of PSL 60 mg/day with a steroid pulse therapy, cyclosporine or an immunosorbent treatment, severe hemolytic anemia remained. However, monthly cyclophosphamide pulse therapy (IV-CY), which was started for the steroid-resistant hemolytic anemia, has gradually become effective and Hb improved up to 11.4 g/dl after 6 courses of IV-CY. (Case 2) A 53-years-old woman diagnosed as SLE in 1978 and she had PSL 5 mg for over 10 years. Severe anemia (Hb 5.9 g/dl) was disclosed with a slight fever in June 2001, and she admitted in our hospital for further examinations. Progressive hemolytic anemia was revealed with marked decrease of Hb (3.4 g/dl) and high titer of direct Coombs (3+). Neither PSL (50 mg/day) nor steroid pulse therapy were effective against hemolytic anemia. In contrast, 3 courses of monthly IV-CY (500 mg/day) resulted in the resolution of hemolysis. It is well known that the steroid-resistant hemolytic anemia is extremely hard to treat and leads to miserable prognosis, but we here propose IV-CY as an alternative and invaluable choice for the treatment of refractory hemolytic anemia complicated with SLE.
authors.affiliation: First Department of Internal Medicine, University of Occupational and Environmental Hearth, School of Medicine, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nakatsuka
authors.forename: Shingo
authors.initials: S
authors.lastname: Nakayamada
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Nakano
authors.forename: Shizuyo
authors.initials: S
authors.lastname: Tsujimura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ota
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy* / Q000209:etiology; D003520:Cyclophosphamide / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D020551:Pulse Therapy, Drug
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide