title: Severe Thrombocytopenia Induced by First Infliximab Administration for Rheumatoid Arthritis.
abstract: Thrombocytopenia due to antitumor necrosis factorα agents is very rare. A 68-year-old woman with rheumatoid arthritis on methotorexate received infliximab (IFX). Three days after the first IFX infusion, she developed gingival bleeding, petechia, and gross hematuria. Her platelet count fell to 2000/μL. We administered a platelet transfusion and intravenous methylprednisolone. Three days after admission, her platelet count was 7000/μL and her bleeding persisted. After double filtration plasmapheresis, her bleeding stopped and her platelet count recovered over 2 weeks. Thrombocytopenia is a rare but severe complication of IFX. Double filtration plasmapheresis may be useful for removing IFX or possible antibodies against platelets when IFX remaining in the patient's blood interferes with improvement of the patient's condition.
authors.affiliation: Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nagai
authors.forename: Naoto
authors.initials: N
authors.lastname: Yokogawa
authors.forename: Kota
authors.initials: K
authors.lastname: Shimada
authors.forename: Shoji
authors.initials: S
authors.lastname: Sugii
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005884:Gingival Hemorrhage / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006417:Hematuria / Q000209:etiology; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects*; D008775:Methylprednisolone / Q000627:therapeutic use; D010956:Plasmapheresis; D017713:Platelet Transfusion; D011693:Purpura / Q000209:etiology; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications / Q000628:therapy
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D000069285:Infliximab; D008775:Methylprednisolone