Successful treatment of a patient with mixed warm and cold antibody mediated Evans syndrome and glucose intolerance.
Thrombocytopenia and autoimmune hemolytic anemia (Evans syndrome) with the presence of both warm and cold autoantibodies (mixed type) are rare in the pediatric age group. This condition may be associated with other autoimmune disorders and is notoriously difficult to treat. This case describes an adolescent male who presented with rapid onset Evans syndrome and diabetes. After failing to respond to high dose prednisone and intravenous immunoglobulin, the patient was successfully treated with monoclonal antibody against CD20 (anti-CD20). This suggests that anti-CD20 is a valuable treatment for severe warm and cold antibody mediated Evans syndrome, and possibly for select cases of antibody mediated diabetes.
Jubinsky
Paul T
PT
Section of Hematology and Oncology, Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Chanin 510, Bronx, NY 10461, USA. pjubinsk@aecom.yu.edu
Rashid
N
N
D000293:Adolescent; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000188:drug therapy*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018149:Glucose Intolerance / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy*; D000069283:Rituximab; D013577:Syndrome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab