title: A case of acquired aplastic anemia with repeated cerebral infarctions at the beginning of immunosuppressive therapy.
abstract: Acquired aplastic anemia is a rare hematopoietic stem-cell disorder that results in pancytopenia and hypocellular bone marrow. The pathophysiology is immune mediated in most cases, with activated type 1 cytotoxic T cells implicated. Acquired aplastic anemia can now be cured or ameliorated by stem-cell transplantation or immunosuppressive drug therapy such as antithymocyte globulin or cyclosporine. We present a rare case report of a 68-year old patient with acquired severe aplastic anemia with repeated cerebral infarctions at the beginning of immunosuppressive therapy. He started immunosuppressive drug therapy with antithymocyte globulin and cyclosporine. During follow-up, magnetic resonance imaging revealed high signals at right thalamus and right pons by diffusion-weighted image. He was diagnosed with repeated cerebral infarctions of right thalamus and right pons. We successfully managed cerebral infarctions by frequent transfusions, edaravone administration, keeping the trough of serum cyclosporine (CsA) concentration around lower limit. This is the first report of successful management of acquired aplastic anemia with repeated cerebral infarctions.
authors.affiliation: Division of Hematology, Ebina General Hospital, Ebina, Kanagawa, Japan. rickey-s@is.icc.u-tokai.ac.jp
authors.forename: Rikio
authors.initials: R
authors.lastname: Suzuki
authors.forename: Ako
authors.initials: A
authors.lastname: Kikuchi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ohgiya
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Murayama
authors.forename: Masako
authors.initials: M
authors.lastname: Toyosaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suyama
authors.forename: Shigeki
authors.initials: S
authors.lastname: Watanabe
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawada
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ando
mesh_terms: D000368:Aged; D000741:Anemia, Aplastic / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D000818:Animals; D002544:Cerebral Infarction / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: D007166:Immunosuppressive Agents