title: A dramatic response to rituximab in a patient with resistant thrombotic thrombocytopenic purpura (TTP) who developed acute stroke.
abstract: BACKGROUND
  Refractory condition can occur in 10-30% of all cases of thrombotic thrombocytopenic purpura despite increased frequency of total plasma exchange. Rituximab can affect the clinical outcome of the refractory cases. However, little is known about usefulness of rituximab on central nervous system involvement mimicking acute ischemic stroke.
  
  
  METHODS
  We report the case of a woman with refractory thrombotic thrombocytopenic purpura who developed an acute onset right sided paralysis, dysarthria, and central facial paralysis, suggestive of cerebrovascular accident while under plasma exchange, corticosteroid, and vincristine therapy.
  
  
  RESULTS
  After initiation of rituximab (375 mg/m(2) weekly for 4 weeks), a dramatic response occurred and the patient's neurologic function recovered fully within days. Sustained remission was achieved, and the patient was well 1 year after her admission, while she was on azathioprine treatment.
  
  
  CONCLUSIONS
  This report suggests that rituximab can provide a good outcome of the dramatic central nervous system involvement in patients with thrombotic thrombocytopenic purpura.
authors.affiliation: Department of Hematology, Baskent University Faculty of Medicine, 06490 Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozdogu
authors.forename: Can
authors.initials: C
authors.lastname: Boga
authors.forename: Ebru
authors.initials: E
authors.lastname: Kizilkilic
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yeral
authors.forename: Ilknur
authors.initials: I
authors.lastname: Kozanoglu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Karatas
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000188:drug therapy*; D000069283:Rituximab; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D007155:Immunologic Factors; D000069283:Rituximab; D001379:Azathioprine