title: A combination of bortezomib and rituximab yields a dramatic response in a woman with highly refractory immune thrombocytopenic purpura: a case report.
abstract: BACKGROUND
  Chronic refractory immune thrombocytopenic purpura can be a challenging condition to treat. By definition, the standard first and second line treatments have failed in these patients and modalities such as thrombopoiesis-stimulating agents and more intensive immunosuppressive drugs are therefore used. However, there still remains a subset of patients who continue to be refractory to treatment.
  
  
  METHODS
  We present the case of a 30-year-old Hispanic woman with recurrent intracranial bleeds, in whom multiple lines of treatment had failed. She was treated with a combination of bortezomib and rituximab based on previously published data that suggested this therapy effectively blocks all antibody-producing cells. Our patient's platelet counts rapidly improved and subsequently normalized following this treatment.
  
  
  CONCLUSIONS
  To the best of our knowledge, this case represents the first report of the effective use of bortezomib and rituximab in highly refractory immune thrombocytopenic purpura. We believe further study of this therapy is warranted in this setting.
authors.affiliation: University of Louisville, 529 South Jackson Street, Louisville, Kentucky 40202, USA. n0vina01@louisville.edu.
authors.forename: Namita
authors.initials: N
authors.lastname: Vinayek
authors.forename: Vivek
authors.initials: V
authors.lastname: Sharma