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Clin J Gastroenterol. 2014 Feb;7(1):74-8. doi: 10.1007/s12328-013-0448-0. Epub 2014 Jan 8.

Pure red cell aplasia associated with autoimmune hepatitis successfully treated with cyclosporine A.

Author information

1
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.
2
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.
3
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.

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.

KEYWORDS:

Autoimmune hepatitis; Cyclosporine; Pure red cell aplasia

PMID:
24523831
PMCID:
PMC3915077
DOI:
10.1007/s12328-013-0448-0
[Indexed for MEDLINE]
Free PMC Article

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