Autoimmune haemolytic anaemia associated with epstein barr virus infection as a severe late complication after kidney transplantation and successful treatment with rituximab: case report

BMC Nephrology

Jason Moore²  Loretta SP Ngu³  Richard J D’Souza²  Jennifer K Williams²  Lynsey H Webb²  Alexander J Hamilton¹ 

[1] Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK;Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK;Department of Haematology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

关键词: Rituximab;    AIHA;    Kidney transplantation;    EBV;   

Others  :  1220007
DOI  :  10.1186/s12882-015-0096-3

 received in 2015-02-17, accepted in 2015-06-25,  发布年份 2015

【 摘 要 】

Background

Autoimmune haemolytic anaemia (AIHA) is a rare complication following kidney transplantation and usually occurs early in its course. It is characterised by autoantibodies or alloantibodies directed against red blood cells (RBCs).

Case presentation

We describe a 44 year old woman who presented 5 years after kidney transplantation with profound transfusion dependent warm AIHA. Investigations confirmed an IgG autoantibody against RBCs and high titre Epstein-Barr virus (EBV) viraemia. The patient was at higher risk for EBV disease being seronegative at the time of transplantation but had detectable EBV capsid IgG antibody at the time of presentation. The haemolysis was refractory to high dose steroid and intravenous immunoglobulin. There was a rapid and complete resolution of both the anaemia and the viraemia following rituximab therapy, with no adverse events. Twenty-six units of blood were required during the course of treatment.

Conclusions

To our knowledge this is the first reported case of EBV associated AIHA in a renal transplant recipient. It highlights a rare pathology associated with post-transplant EBV infection, of broad interest to transplant physicians, haematologists, and microbiologists, and the effective novel use of monoclonal anti-CD20 therapy.

【 授权许可】

   
2015 Hamilton et al.

【 图 表 】

Fig. 1.

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