Hutchinson Anna L, Tan Yi Ling, Kidson-Gerber Giselle
Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia.
Department of Medicine, University of New South Wales, Botany Street, Sydney, NSW 2052, Australia.
Case Rep Hematol. 2013;2013:703027. doi: 10.1155/2013/703027. Epub 2013 Dec 18.
This case report describes a patient with an idiopathic acquired Factor VIII inhibitor and severe bleeding. She was treated with rituximab after failing first-line treatment with steroids and cyclophosphamide. Two months following rituximab treatment, our patient developed a succession of severe opportunistic infections requiring intensive care unit admission. Over a period of 12 weeks she required treatment for Pseudomonas aeruginosa septicaemia, herpes simplex gingivostomatitis and pharyngotonsillitis, clostridium difficile-related diarrhoea, systemic cytomegalovirus infection, pneumocystis jiroveci, and invasive pulmonary aspergillosis lung infections. After significant rehabilitation, the patient was finally discharged following a 5-month admission. This case highlights the complexity of balancing a life-threatening condition with the side effects of treatment. It also raises the issue of routine prophylaxis for immunosuppression in nonmalignant conditions, which will become a common dilemma with the expanding indications for rituximab use.
本病例报告描述了一名患有特发性获得性凝血因子VIII抑制剂且严重出血的患者。在一线使用类固醇和环磷酰胺治疗失败后，她接受了利妥昔单抗治疗。利妥昔单抗治疗两个月后，我们的患者出现了一系列严重的机会性感染，需要入住重症监护病房。在12周的时间里，她需要治疗铜绿假单胞菌败血症、单纯疱疹性龈口炎和咽扁桃体炎、艰难梭菌相关性腹泻、系统性巨细胞病毒感染、耶氏肺孢子菌肺炎和侵袭性肺曲霉病肺部感染。经过大量康复治疗后，患者在入院5个月后最终出院。该病例突出了在危及生命的病情与治疗副作用之间进行平衡的复杂性。它还提出了在非恶性疾病中进行免疫抑制常规预防的问题，随着利妥昔单抗使用适应症的扩大，这将成为一个常见的困境。
