Ierardi E, Rendina M, Francavilla R, Barone M, Castellaneta A, Panella C, Francavilla A, Cuomo R
Chair of Gastrenterology, University of Foggia, Foggia, Italy.
J Viral Hepat. 2003 Sep;10(5):390-3. doi: 10.1046/j.1365-2893.2003.00438.x.
We report two cases of hepatitis C virus (HCV) associated autoimmune haematological disorders successfully treated with an unusual protocol (mycophenolate mofetil: MMF). The first case was a male patient with chronic HCV infection who developed, during interferon (IFN)/ribavirin therapy, severe autoimmune thrombocytopenia unresponsive to steroids. MMF was then administered and, simultaneously, the steroid dose was gradually reduced until withdrawal. Following this strategy, a progressive increase in platelet count and complete negativity of anti-PLT antibodies were achieved without changes in HCV-RNA quantitative determination. The second case was a woman with HCV liver cirrhosis with severe anaemia and Coombs test positivity partially responsive to continuous administration of steroid high doses. However, this treatment unmasked a severely painful vertebral osteoporosis. For this reason we introduced MMF and simultaneously steroid therapy was progressively reduced until withdrawal. Haemoglobin reached a normal value and the Coombs test became negative within 60 days. These case reports suggest that MMF may represent an interesting therapeutic approach for autoimmune HCV associated haematological disorders.
我们报告了两例丙型肝炎病毒（HCV）相关的自身免疫性血液系统疾病患者，采用一种不同寻常的方案（霉酚酸酯：MMF）成功治愈。第一例是一名慢性HCV感染男性患者，在干扰素（IFN）/利巴韦林治疗期间，出现严重的自身免疫性血小板减少症，对类固醇治疗无反应。随后给予MMF治疗，同时逐渐减少类固醇剂量直至停用。按照此策略，血小板计数逐渐增加，抗血小板抗体完全转阴，而HCV-RNA定量测定无变化。第二例是一名患有HCV肝硬化的女性，伴有严重贫血，库姆斯试验阳性，对持续高剂量类固醇治疗部分有效。然而，这种治疗引发了严重疼痛的椎体骨质疏松症。因此，我们引入了MMF，同时逐渐减少类固醇治疗直至停用。血红蛋白在60天内恢复到正常水平，库姆斯试验转阴。这些病例报告表明，MMF可能是治疗HCV相关自身免疫性血液系统疾病一种有前景的治疗方法。
