Primary Sjögren Syndrome Complicated by Autoimmune Hemolytic Anemia and Pure Red Cell Aplasia

• Published in: The American journal of the medical sciences 2007-12, Vol.334 (6), p.493-496
• Main Authors: Assimakopoulos, Stelios F., Michalopoulou, Sotiria, Melachrinou, Maria, Giannakoulas, Nikolaos, Papakonstantinou, Christos, Lekkou, Alexandra, Gogos, Charalambos
• Format: Article
• Language: English
• Subjects: Aged; Anemia, Hemolytic, Autoimmune - diagnosis; Anemia, Hemolytic, Autoimmune - drug therapy; Anemia, Hemolytic, Autoimmune - etiology; Autoimmune hemolytic anemia; Biological and medical sciences; Bone Marrow - pathology; Diagnosis, Differential; Female; General aspects; Humans; Medical sciences; Pure red cell aplasia; Red-Cell Aplasia, Pure - diagnosis; Red-Cell Aplasia, Pure - drug therapy; Red-Cell Aplasia, Pure - etiology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sjogren's Syndrome - blood; Sjogren's Syndrome - complications; Sjogren's Syndrome - drug therapy; Sjögren syndrome
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1097/MAJ.0b013e318068b5fd

Patients with primary Sjögren syndrome frequently present hematologic abnormalities, consisting mainly of immune cytopenias. Pure red cell aplasia is a very rare complication of primary Sjögren syndrome. This is the first report in the literature describing the development of pure red cell aplasia combined with autoimmune hemolytic anemia in a 74-year-old woman with primary Sjögren syndrome. In our patient, despite administration of diverse therapeutic schemes, such as corticosteroids, immunomodulating agents (intravenous immune globulin), immunosuppressive drugs (cyclophosphamide), and novel treatment options (monoclonal antibody directed against the CD20 antigen), no response was achieved. The present case suggests that the possibility of comorbid connective tissue disease should be a diagnostic consideration in patients with acquired pure red cell aplasia and autoimmune hemolytic anemia. Although most of the hematologic abnormalities that occur in primary Sjögren syndrome are not clinically significant, serious and difficult-to-treat hematologic complications may also occur.