Successful Use of Cyclosporine as An Adjunctive Immunosuppressive Agent in An Infantile Evans Syndrome: A Case Report and Literature Review

Abstract

Summary :

We report a successful treatment of cyclosporine in a 3-month-old female infant with Evans syndrome after a partial response to conventional IVIG and corticosteroids. With an implement of oral cyclosporine as an adjunctive treatment, most of hematological parameters have shown a notable improvement by 3-month maintenance therapy. No major complication was observed during treatment and this infant remained well at 6 months after cyclosporine cessation.
In an infant with Evans syndrome who resisted to the first line medications, the second line immunosuppressive agent should be introduced in order to minimize autoantibody synthesis and to reduce the major side effects of long-term corticosteroids use. From the literature review, low dose cyclosporine appeared to be beneficial in refractory autoimmune cytopenia included Evans syndrome. However, limited number of infants were evaluated their responses after cyclosporine treatment in previously published reports.