title: Acquired haemophilia A in a patient with chronic hepatitis C virus infection receiving treatment with pegylated interferon plus ribarivin: role of rituximab.
abstract: BACKGROUND
  Acquired haemophilia is an uncommon condition caused by the development of clotting factor inhibitors. To eliminate them, immunosuppressive therapy with corticosteroids and cytotoxic drugs is required.
  
  
  METHODS
  We describe a case of rituximab use in acquired haemophilia refractory to conventional therapy in a 63 year old male patient with chronic hepatitis C virus infection who was receiving treatment with pegylated-interferon-a-2a plus ribavirin.
  
  
  RESULTS
  After 21 weeks of antiviral therapy, the patient was admitted to hospital with a large haematoma in the abdominal muscles. Factor VIII level was zero and inhibitor titer was 345 Bethesda units. Oral immunosuppressive therapy with methylprednisolone and cyclophosphamide was administered for 1 month, with limited improvement. Therefore, cyclophosphamide was replaced by a four once-weekly dose of intravenous rituximab. Two months later, factor VIII level was normal and inhibitor titer was undetectable.
  
  
  CONCLUSIONS
  Rituximab may be useful for the treatment of acquired haemophilia resistant to standard therapy.
authors.affiliation: Servicio de Farmacia. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia. España.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Fernández de Palencia Espinosa
authors.forename: V
authors.initials: V
authors.lastname: Arocas Casañ
authors.forename: B
authors.initials: B
authors.lastname: Garrido Corro
authors.forename: A
authors.initials: A
authors.lastname: de la Rubia Nieto
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D005169:Factor VIII / Q000032:analysis; D006406:Hematoma / Q000139:chemically induced; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin; D000069283:Rituximab; D003520:Cyclophosphamide; D005169:Factor VIII; D011239:Prednisolone