SciELO - Scientific Electronic Library Online

vol.139 issue11Late diagnosis of nodular melanoma of the foot in a 74-year-old Brazilian manSpinal lumbar stenosis: An update author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links


Revista médica de Chile

Print version ISSN 0034-9887


CAREY, Elizabeth J; SOMARATNE, Krishni  and  RAKELA, Jorge. Successful rituximab therapy in refractory autoimmune hepatitis and Evans syndrome. Rev. méd. Chile [online]. 2011, vol.139, n.11, pp.1484-1487. ISSN 0034-9887.

A 44-year-old woman was found to have elevated aminotransferases, twice the upper limit of normal. Liver biopsy demonstrated a mixed inflammatory process suggestive of both primary biliary cirrhosis and autoimmune hepatitis (AIH). Prednisone and azathioprine were started, with normalization of aminotransferases. Six months later, she returned with worsening pruritus and re-evaluation demonstrated probable reactivation of AIH with acute elevation of liver injury tests. Repeat liver biopsy was suggestive of a flare of AIH which did not respond to prednisone, azathioprine, or mycophenolate mofetil. One month later the patient was hospitalized for sudden onset of anemia and thrombocytopenia, suggestive of autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura consistent with Evans syndrome. Rituximab was initiated and mycophenolate mofetil discontinued. After one infusion of rituximab, liver injury tests significantly improved. Within four weeks of rituximab infusion (4 doses) the patient's Evans syndrome completely resolved with normal hemoglobin and platelet levels; aminotransferases also significantly improved to less than twice the upper limit of normal.

Keywords : Anemia; hemolytic; autoimmune; Evans syndrome; Hepatitis; autoimmune; Rituximab.

        · text in English     · English ( pdf )


Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License