title: Recurrent spontaneous subdural hematoma secondary to immune thrombocytopenia in a patient with overlap syndrome.
abstract: Patients with autoimmune connective tissue disease may manifest as overlap syndrome with features of systemic lupus erythematosus (SLE), systemic sclerosis, rheumatoid arthritis and myositis. Those presenting with active SLE can present with immune thrombocytopenia (IT) and may be complicated with subdural hematoma which, though rare, is potentially life-threatening. We report here a patient with overlap syndrome who had recurrent spontaneous subdural hematoma due to severe thrombocytopenia which did not respond to corticosteroids and azathioprine. Her platelet count became normal with three doses of low-dose intravenous cyclophosphamide (IV CYC) given at 3-weekly intervals. She remained in remission with maintenance therapy with azathioprine.
authors.affiliation: Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: K G
authors.initials: KG
authors.lastname: Goh
authors.affiliation: Department of Medicine, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia ongsweeg@gmail.com.
authors.forename: S G
authors.initials: SG
authors.lastname: Ong
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy*; D008775:Methylprednisolone / Q000627:therapeutic use; D010976:Platelet Count; D011859:Radiography; D012008:Recurrence; D012595:Scleroderma, Systemic / Q000150:complications; D013921:Thrombocytopenia / Q000150:complications* / Q000276:immunology; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine; D008775:Methylprednisolone
keywords: Systemic lupus erythematosus; immune thrombocytopenia; recurrent subdural hematoma