Liao Tiantian, Li Mengqing, Yuan Tian, Hong Qifu, Zeng Yu, Yu Dan, Yu Qiong, Yu Limei, Pu Tao
Department of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Key Laboratory of Cell Engineering, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Front Pharmacol. 2022 Oct 25;13:1041884. doi: 10.3389/fphar.2022.1041884. eCollection 2022.
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation. In recent decades, biological agents such as anti-tumor necrosis factor-α (TNF-α) drugs have been applied in the treatment of RA and it achieved great improvement. The treatment has its side effects, but severe thrombocytopenia is very rare. In this case report we described the occurrence of severe thrombocytopenia in a patient with RA who was treated with adalimumab. Specially, the symptoms of the RA are not significantly improved by adalimumab treatment and severe thrombocytopenia it induced is resistant to treatment. After receiving four doses of adalimumab, the patient's platelet count dropped to 4 × 10/μl. We halted adalimumab and administered glucocorticoids, interleukins, and platelet transfusion. On the sixth day, the platelet count rose to 52 × 10/μl. Lab tests and bone marrow pictures were unremarkable. Patient was treated with prednisone for maintenance. On day 17, the platelet count declined to 12 × 10/μl. We started the patient on methylprednisolone and recombinant human thrombopoietin (rh-TPO), but the effect was not significant. On day 25, intravenous immune globulin (IVIG) was applied in place of the rh-TPO. On 29th day, the patient's platelets returned to normal. We summarized the existing literature on thrombocytopenia induced by anti-TNF-α drugs. This case suggested immunoglobulins could be considered for the treatment of refractory thrombocytopenia.
类风湿关节炎（RA）是一种以持续性关节炎症为特征的慢性炎症性疾病。近几十年来，生物制剂如抗肿瘤坏死因子-α（TNF-α）药物已应用于RA的治疗并取得了显著进展。这种治疗有其副作用，但严重血小板减少症非常罕见。在本病例报告中，我们描述了一名接受阿达木单抗治疗的RA患者发生严重血小板减少症的情况。具体而言，阿达木单抗治疗并未使该患者的RA症状得到明显改善，且其所诱导的严重血小板减少症对治疗具有抵抗性。在接受四剂阿达木单抗后，患者的血小板计数降至4×10/μl。我们停用了阿达木单抗，并给予糖皮质激素、白细胞介素和血小板输注。第六天，血小板计数升至52×10/μl。实验室检查和骨髓图片均无异常。患者接受泼尼松维持治疗。第17天，血小板计数降至12×10/μl。我们开始给予患者甲泼尼龙和重组人血小板生成素（rh-TPO），但效果不显著。第25天，静脉注射免疫球蛋白（IVIG）替代rh-TPO。第29天，患者的血小板恢复正常。我们总结了关于抗TNF-α药物诱导血小板减少症的现有文献。该病例提示免疫球蛋白可考虑用于治疗难治性血小板减少症。
