Fulminant Microangiopathic Hemolytic Anemia Prior Seropositive Antinuclear Antibody: A Difficulty in Diagnosis and Management, Successfully Treated with Methylprednisolone Plus Chemotherapy: A Case Report
Keywords:
Microangiopathic hemolytic anemia, Antinuclear antibody, MethylprednisoloneAbstract
Abstract: We report a case of thirty-two years old woman came with severe headache for 7 days and alteration of consciousness for 5 days She had no underiving disease, any medications and fever during this period of illness. Complete blood count showed anemia with thrombocytopenia and the peripheral blood smear and bone marrow study were compatible with microangiopathic hemolytic anemia. Laboratory tests showed BUN 23 mg/dl, creatinine 0.9 mg/dL, direct bilirubin 0 3 mg/dl, indirect bilirubin 2.8 mg/dl. The connective tissue disease study revealed positive AMA1:80 (speckled pattern), negative anti-ds-DNA, negative VDRL. The CT scan of brain showed no any hemorrhage or infarction. The patient gradually recovered and fully gained consciousness after 10 days of treatment with plasma infusion, methyl prednisolone and chemotherapy (endoxan, vincristine). The complete blood count returned to normal after 30 days of therapy. Prednisolone was maintained and tapered off one year later. The serology for ANA was re-tested afterward after 6 months and showed positive ANA >1:320 (nucleolar pattem) which converted to negative after 10 months.
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