A case of successful pregnancy following multidrug treatment including rituximab and intravenous immunoglobulin for primary antiphospholipid antibody syndrome refractory to conventional treatment

Abstract

Antiphospholipid antibody syndrome (APS) is defined by the presence of clinical symptoms caused by antiphospholipid antibodies. When APS occurs during pregnancy, it is conventionally treated with low-dose aspirin or heparin. In cases refractory to conventional treatment, intravenous immunoglobulin (IvIg) is sometimes added. We present the case of an APS patient with severe thrombocytopenia who experienced a successful pregnancy after treatment that included intravenous rituximab and IvIg. As far as we know, this is the first report demonstrating a positive pregnancy outcome in this context. Physicians may consider prescribing not only IvIg but also rituximab during the first trimester of pregnancy in APS patients with severe obstetrical complications and thrombocytopenia refractory to conventional treatment.

Keywords:

• Antiphospholipid antibody syndrome
• pregnancy
• rituximab
• thrombocytopenia

Patient consent

Our patient provided written informed consent for publication of this article.

Conflict of interest

Atsuko Murashima received research grants/honoraria from Astellas Pharma Co. Ltd., Chugai Pharmaceutical Co. Ltd., and Mitsubishi Tanabe Pharma Co., Ltd. All other authors have declared no conflicts of interest.

Additional information

Funding

This work was supported by AMED under Grant Number [JP18mk0101086].