Successful treatment of a patient with refractory immune thrombocytopenic purpura in systemic lupus erythematosus with rituximab

Figures & data

Figure 1. Clinical course of the CS-resistant SLE-ITP patient. PSL: prednisolone; mPSL: methylprednisolone; HCQ: hydroxychloroquine; RTX: rituximab; SLEDAI: systemic lupus erythematosus disease activity index; C3: Complement 3; C4: Complement 4; PA-IgG: platelet-associated IgG.

Table 1. Laboratory findings at admission.

Complete blood count		Biochemistry		Serological
White blood cell	4200 /μl	T-Bil	0.25 mg/dl	C3	56.7 mg/dl
Segmented	84%	ALP	182 U/L	C4	17.7 mg/dl
Lymphocyte	13%	γ-GTP	14 U/L	CH50	10.6 U/ml
Monocyte	1%	AST	34 U/L	RF	6 IU/ml
Eosinophils	0%	ALT	10 U/L	ANA	1:2560 (homogenous, speckled pattern)
Hemoglobin	8.6 g/dl	LDH	312 U/L
Platelets	0.6 × 10^4 /μl	CPK	61 U/ml
Coagulation		Tp	7.4 g/dl	Anti-dsDNA	7.9 IU/ml
PT (INR)	1.09	Alb	2.5 g/dl	Anti-Sm	4.1 U/ml
APTT	35.3s	BUN	26.9 mg/dl	Anti-SS-A	>1200 U/ml
Fibrinogen	324mg/dl	Cr	0.85 mg/dl	Anti-SS-B	2.8 U/ml
D-dimer	3.41 μg/ml	Na	136 mEq/l	MPO-ANCA	<1.0 U/ml
LA	1.4 ratio	K	4.4 mEq/l	PR3-ANCA	<1.0 U/ml
Urinalysis		Cl	102 mEq/l	PA-IgG	708.3 ng/10^7
pH	5.5	Ferritin	406.7ng/ml	erythrocyte sedimentation rate	77 mm/h
Protein	(1+)	CRP	2.9 mg/dl	aCL antibody (IgG)	<8 U/ml
Red blood cells	(−)	IgG	2885 mg/dl	β2GPIaCL	<0.7 U/ml
White blood cells	(−)	IgM	147 mg/dl
Pathologic cells	(−)	IgA	505 mg/dl

PT (INR): Prothrombin time (international normalized ratio); APTT: Activated partial thromboplastin time; LA: lupus anticoagulant; PH: potential of hydrogen; T-Bil: Total bilirubin; ALP: Alkaline phosphatase; γ-GTP: γ-glutamyltransferase; AST: Aspartic aminotransferase; ALT: Alanine aminotransferase; LDH: Lactate dehydrogenase; CPK: Creatine phosphokinase; TP: Total protein; Alb: Albumin; BUN: blood urea nitrogen; Cr: Creatinine; CRP: C-reactive protein; C3: Complement 3; C4: Complement 4; CH50: total hemolytic complement; RF: Rheumatoid factor; ANA: antinuclear antibody; Anti-dsDNA: Anti double-stranded deoxyribonucleic acid antibodies; Anti-sm: Anti Smith antibodies; Anti-SS-A: Anti SS-A antibody; Anti-SS-B: Anti SS-B antibody; MPO-ANCA: Myeloperoxidase antineutrophil cytoplasmic autoantibodies; PR3-ANCA: Proteinase 3 antineutrophil cytoplasmic autoantibodies; PA-IgG: platelet-associated IgG; aCL: anticardiolipin; β2GPIaCL: β2-glycoprotein I dependent anticardiolipin antibody.