Korean J Med.  2015 Dec;89(6):709-713. 10.3904/kjm.2015.89.6.709.

Successful Treatment with Low-dose Rituximab in a Patient with Plasma Exchange-refractory Idiopathic Thrombotic Thrombocytopenic Purpura

• Song KH
• Hong J
• Hwang H
• Kang E
• Park J
• Ahn JY
• Lee JH

• KMID: 2268930
• DOI: http://doi.org/10.3904/kjm.2015.89.6.709

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a clinical syndrome characterized by micro-angiopathic hemolytic anemia, thrombocytopenia, fever, renal disorders, and neurological manifestations. Its clinical course is rapid and the mortality rate is high if untreated or relapse occurs. Previous studies reported that rituximab, a monoclonal antibody for CD20 surface antigen on B lymphocytes, may be effective in treating idiopathic TTP that is refractory to plasma exchange or relapses after remission. A 27-year-old Vietnamese man presented with fever and fatigue starting 3 days earlier, which was diagnosed as idiopathic TTP. To overcome his poor responsiveness to combined therapy using steroids and plasma exchange, rituximab was considered. In the current case, the patient was treated with a lower dose of rituximab, instead of the conventional 375 mg/m2/week, and achieved successful remission.

Keyword

Purpura, Thrombotic thrombocytopenic; Thrombotic microangiopathies; Glucocorticoids; Plasma exchange; Rituximab

MeSH Terms

Adult
Anemia, Hemolytic
Antigens, Surface
Asian Continental Ancestry Group
B-Lymphocytes
Fatigue
Fever
Glucocorticoids
Humans
Mortality
Neurologic Manifestations
Plasma Exchange
Plasma*
Purpura, Thrombotic Thrombocytopenic*
Recurrence
Steroids
Thrombocytopenia
Thrombotic Microangiopathies
Rituximab
Antigens, Surface
Glucocorticoids
Steroids