title: Pure red cell aplasia associated with autoimmune hepatitis successfully treated with cyclosporine A.
abstract: A 47-year-old female with a 17-year history of autoimmune hepatitis had been treated with prednisolone, azathioprine, and ursodeoxycholic acid. Although her alanine aminotransferase level occasionally showed mild abnormality, the prednisolone dose could not be increased because she had developed cataract during the course of her illness. In May 2012, she developed severe normochromic normocytic anemia without hemorrhage, and azathioprine was discontinued because it was suspected of being the cause. However, anemia recurred frequently even after discontinuation, necessitating repeated blood transfusions. Bone marrow analysis revealed selective erythroblastopenia, thus leading to a diagnosis of pure red cell aplasia. Cyclosporine A was administered, which led to a dramatic recovery from anemia, and stabilized her alanine aminotransferase levels. Furthermore, the prednisolone dose could be gradually tapered. Pure red cell aplasia associated with autoimmune hepatitis is extremely rare. The present case shows that patients with autoimmune hepatitis refractory to the standard treatment regimen and those with concomitant pure red cell aplasia may be treated with cyclosporine A.
authors: Division of Gastroenterology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho Asahi-ku, Yokohama, 241-0811 Japan.
authors: Akira
authors: A
authors: Sato
authors: Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho Asahi-ku, Yokohama, 241-0811 Japan.
authors: Fumiaki
authors: F
authors: Sano
authors: Division of Gastroenterology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho Asahi-ku, Yokohama, 241-0811 Japan.
authors: Toshiya
authors: T
authors: Ishii
authors: Division of Gastroenterology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho Asahi-ku, Yokohama, 241-0811 Japan.
authors: Kayo
authors: K
authors: Adachi
authors: Division of Gastroenterology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho Asahi-ku, Yokohama, 241-0811 Japan.
authors: Ryujirou
authors: R
authors: Negishi
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511 Japan.
authors: Nobuyuki
authors: N
authors: Matsumoto
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511 Japan.
authors: Chiaki
authors: C
authors: Okuse
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D012010:Red-Cell Aplasia, Pure / Q000150:complications* / Q000188:drug therapy*; D012074:Remission Induction
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: Autoimmune hepatitis; Cyclosporine; Pure red cell aplasia