title: Evans syndrome following long-standing Hashimoto's thyroiditis and successful treatment with rituximab.
abstract: We report a case of a 51-year-old woman with Evans syndrome (autoimmune hemolytic anemia and primary immune thrombocytopenia) and hypothyroidism. She was previously diagnosed with Hashimoto's thyroiditis in 1994 (age, 35) and autoimmune hemolytic anemia (AIHA) 3 years ago. She was treated with oral prednisolone. After a period, in which the anemia waxed and waned, there was an abrupt development of thrombocytopenia (nadir 15×10(9)/L) that coincided with the tapering off of prednisolone after 3 years of administration. Because her thrombocytopenia was refractory to prednisolone, we administered rituximab (375 mg/m(2) weekly) for 4 weeks. Two weeks after the completion of the rituximab treatment, her platelet count was up to 92×10(9)/L. No intermittent peaking of thyroid stimulating hormone occurred after rituximab treatment was initiated. Evans syndrome and autoimmune thyroiditis might share common pathophysiological mechanisms. This notion supports the use of rituximab in a patient suffering from these disorders.
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Oh
authors.forename: Myung Jae
authors.initials: MJ
authors.lastname: Yun
authors.forename: Seong Tae
authors.initials: ST
authors.lastname: Lee
authors.forename: Seung June
authors.initials: SJ
authors.lastname: Lee
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Oh
authors.forename: In
authors.initials: I
authors.lastname: Sohn