title: Two cases of refractory thrombocytopenia in systemic lupus erythematosus that responded to intravenous low-dose cyclophosphamide.
abstract: Treatment of thrombocytopenia in systemic lupus erythematosus (SLE) is considered in cases of current bleeding, severe bruising, or a platelet count below 50,000/µL. Corticosteroid is the first choice of medication for inducing remission, and immunosuppressive agents can be added when thrombocytopenia is refractory to corticosteroid or recurs despite it. We presented two SLE patients with thrombocytopenia who successfully induced remission after intravenous administration of low-dose cyclophosphamide (CYC) (500 mg fixed dose, biweekly for 3 months), followed by azathioprine (AZA) or mycophenolate mofetil (MMF). Both patients developed severe thrombocytopenia in SLE that did not respond to pulsed methylprednisolone therapy, and started the intravenous low-dose CYC therapy. In case 1, the platelet count increased to 50,000/µL after the first CYC infusion, and remission was maintained with low dose prednisolone and AZA. The case 2 achieved remission after three cycles of CYC, and the remission continued with low dose prednisolone and MMF.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Mi-Il
authors.initials: MI
authors.lastname: Kang
authors.forename: Yoon
authors.initials: Y
authors.lastname: Kang
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Chung
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Lee
authors.forename: Yong-Beom
authors.initials: YB
authors.lastname: Park
authors.forename: Soo-Kon
authors.initials: SK
authors.lastname: Lee
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010976:Platelet Count; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine
keywords: Cyclophosphamide; Systemic Lupus Erythematosus; Thrombocytopenia