Delayed and Long-term Remission of Refractory Hemolytic Anemia in a Child with Systemic Lupus Erythematosus Treated with Rituximab

Ju Hwan Park; Jae Wook Im; Hong Kil Jun; Hae Min Park; Seung Won Choi; Sang Kyu Park; Ji Seon Oh

doi:10.4078/jrd.2014.21.4.196

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Park, Im, Jun, Park, Choi, Park, and Oh: Delayed and Long-term Remission of Refractory Hemolytic Anemia in a Child with Systemic Lupus Erythematosus Treated with Rituximab

Case Report

J Rheum Dis 2014;21(4):196-200.

Published online: 31 October 2014

DOI: https://doi.org/10.4078/jrd.2014.21.4.196

Delayed and Long-term Remission of Refractory Hemolytic Anemia in a Child with Systemic Lupus Erythematosus Treated with Rituximab

Ju Hwan Park¹, Jae Wook Im¹, Hong Kil Jun¹, Hae Min Park¹, Seung Won Choi¹, Sang Kyu Park², Ji Seon Oh¹

¹Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

²Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Corresponding to: Ji Seon Oh, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 682-060, Korea. E-mail: jsoh@uuh.ulsan.kr

Received 31 May 2013 Revised 18 July 2013 Accepted 5 August 2013

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

REFERENCES

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Figure 1.

Kidney ultrasonography reveals diffuse increased echogenecity of medulla of both kidneys, suggesting medullary nephrocalcinosis.

Figure 2.

Trends of hemoglobin and total bilirubin levels before and after rituximab treatment. The bar graph stands for daily amounts of oral steroid calculated in terms of prednisolone. Hemoglobin level increased, and total bilirubin level and the doses of oral steroid decreased after the use of rituximab. SLE, systemic lupus erythematosus; HA, hemolytic anemia.

Table 1.

Laboratory findings before and after rituximab treatment in a child with systemic lupus erythematosus and hemolytic anemia

Rituximab administration
	2008/07	2008/12	2009/04	2009/09	2009/12	2010/01	2010/02	2010/04	2010/07	2011/02	2011/09	2012/04	2012/07	2012/09	2012/12	2013/03
Hb (/dL)	7.1	10.1	5.6	8.3	6.8	12.9	10.6	8.9	9.9	11.7	13.1	13.1	13.4	14.8	13.7	13.8
CRC (%)	5.38	−	7.37	12.75	5.53	2.96	7.14	5.9	5.92	3.17	1.12	1.43	1.16	1.44	0.93	1.01
CD19 (/uL)	−	−	−	−	−	165	0.4	0.3	0.7	11.4	26.8	−	312	−	−	−
IgA (mg/dL)	−	−	−	−	−	101	−	−	46	3	2	−	0	0	2	0
IgM (mg/dL)	−	−	−	−	−	130	−	−	＜25	＜25	＜25	−	＜25	＜25	＜25	＜25
IgG (mg/dL)	−	−	−	−	−	754	−	−	579	585	557	−	376	369	355	＜300
K (mM/L)	2.3	5.1	3.9	4.5	4.8	4.3	3.8	4.2	−	4	−	4.4	4	4	4.2	4.3
tCO2 (mmol/L)	14	23	24	23	28	28	28	25	−	29	−	23	24	26	26	25
Supplementation of potassium citrate

Hb: hemoglobin, CRC: corrected reticulocyte count, CD: Cluster of Differentiation, IgA: immunoglobulin A, IgM: immunoglobulin M, IgG: immunoglobulin G, K: potassium, tCO2: total carbon dioxide.

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