High dose corticosteroid therapy for anti-thymocyte globulin associated severe serum sickness in an adult patient with aplastic anemia

Aydin, Muruvvet Seda; Do�an, �smail; Ceran, Funda; Da�da�, Simten; Ozet, Gulsum

High dose corticosteroid therapy for anti-thymocyte globulin associated severe serum sickness in an adult patient with aplastic anemia [Haydarpasa Numune Med J]

Haydarpasa Numune Med J. Ahead of Print: HNHJ-70846

High dose corticosteroid therapy for anti-thymocyte globulin associated severe serum sickness in an adult patient with aplastic anemia

Muruvvet Seda Aydin¹, �smail Do�an², Funda Ceran¹, Simten Da�da�¹, Gulsum Ozet¹
¹Department of Hematology, Ankara City Hospital, Ankara, Turkey
²Department of Rheumatology, Ankara City Hospital, Ankara, Turkey

Classical serum sickness is a type III immune complex-mediated hypersensitivity disease caused by immunization of the host by non-human serum proteins. Anti-thymocyte globulin is one of the agents mostly responsible. Prophylactic steroids are used in the treatment protocol of aplastic anemia in addition to anti-thymocyte globulin. A 33-year-old female patient diagnosed with aplastic anemia case developed severe serum sickness with anti-thymocyte globulin, despite administration of prophylactic dose of methylprednisolone. The patient responded dramatically to a single dose of pulse steroid therapy. There are reports that high dose steroids (1-2 mg/kg/day to 500-1000 mg/day methylprednisolone) and/or therapeutic plasma exchange as beneficial treatment options. Our report shows the benefit of single pulse dose steroid and gradual tapering the dose in this case.

Keywords: Anti-thymocyte globulin, Aplastic Anemia, Immunology, Methylprednisolone, Serum Sickness

Eri�kin aplastik anemili hastada anti-timosit globulin ili�kili ciddi serum hastal��n�n y�ksek doz kortikosteroid ile tedavisi

Muruvvet Seda Aydin¹, �smail Do�an², Funda Ceran¹, Simten Da�da�¹, Gulsum Ozet¹
¹Ankara �ehir Hastanesi, Hematoloji B�l�m�, Ankara
²Ankara �ehir Hastanesi, Romatoloji B�l�m�, Ankara

Klasik serum hastal��, konak��n�n insan d�� serum proteinleri taraf�ndan ba��klamas�n�n neden oldu�u, tip III imm�n-kompleks arac�l� hipersensitivitedir. Anti-timosit globulin en �ok sorumlu olan ajanlardan biridir. Aplastik aneminin tedavi protokol�nde anti-timosit glob�line ek olarak profilaktik steroidler kullan�lmaktad�r. Aplastik anemi tan�s� alan 33 ya��ndaki kad�n hastada profilaktik dozda metilprednizolon uygulanmas�na ra�men anti-timosit glob�lin ile a��r serum hastal�� geli�ti. Hasta tek doz pulse steroid tedavisine dramatik yan�t verdi. Y�ksek doz steroid (1-2 mg/kg/g�n ile 500-1000 mg/g�n metilprednizolon) ve/veya terap�tik plazma de�i�iminin yararl� tedavi se�enekleri oldu�u bildirilmektedir. Raporumuz, bu olguda tek doz steroidin ve dozu kademeli olarak azaltman�n faydas�n� g�stermektedir.

Anahtar Kelimeler: Antitimosit globulin, Aplastik Anemi, �mm�noloji, Metilprednizolon, Serum Hastal��

Corresponding Author: Muruvvet Seda Aydin, T�rkiye
Manuscript Language: English

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High dose corticosteroid therapy for anti-thymocyte globulin associated severe serum sickness in an adult patient with aplastic anemia

Eri�kin aplastik anemili hastada anti-timosit globulin ili�kili ciddi serum hastal���n�n y�ksek doz kortikosteroid ile tedavisi

Eri�kin aplastik anemili hastada anti-timosit globulin ili�kili ciddi serum hastal��n�n y�ksek doz kortikosteroid ile tedavisi