Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2024; 12(13): 2286-2292
Published online May 6, 2024. doi: 10.12998/wjcc.v12.i13.2286
Refractory autoimmune hemolytic anemia in a patient with systemic lupus erythematosus and ulcerative colitis: A case report
Dai-Xing Chen, Yue Wu, Sui-Feng Zhang, Xiao-Jun Yang
Dai-Xing Chen, Yue Wu, Sui-Feng Zhang, Xiao-Jun Yang, Department of Digestive System, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
Author contributions: Chen DX and Wu Y contributed to writing and editing of the manuscript and to collecting the data; Zhang SF contributed to the data analysis; Yang XJ contributed to the conceptualization and supervision. All the authors have read and approved the final manuscript.
Informed consent statement: All participants in the study or their legal guardians provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Jun Yang, MD, PhD, Chief Doctor, Department of Digestive System, Chongqing Traditional Chinese Medicine Hospital, No. 6 Panxi 7 Branch Road, Jiangbei District, Chongqing 400021, China. yangxj88@126.com
Received: January 23, 2024
Peer-review started: January 23, 2024
First decision: January 31, 2024
Revised: February 6, 2024
Accepted: March 27, 2024
Article in press: March 27, 2024
Published online: May 6, 2024
Abstract
BACKGROUND

Ulcerative colitis (UC) and systemic lupus erythematosus (SLE) are both systemic immunoreactive diseases, and their pathogenesis depends on the interaction between genes and environmental factors. There are no reports of UC with SLE in China, but six cases of SLE with UC have been reported in China. The combination of these two diseases has distinct effects on the pathogenesis of both diseases.

CASE SUMMARY

A female patient (30 years old) came to our hospital due to dull umbilical pain, diarrhea and mucous bloody stool in August 2018 and was diagnosed with UC. The symptoms were relieved after oral administration of mesalazine (1 g po tid) or folic acid (5 mg po qd), and the patient were fed a control diet. On June 24, 2019, the patient was admitted for treatment due to anemia and tinnitus. During hospitalization, the patient had repeated low-grade fever and a progressively decreased Hb level. Blood tests revealed positive antinuclear antibody test, positive anti-dsDNA antibody, 0.24 g/L C3 (0.9-1.8 g/L), 0.04 g/L C4 (0.1-0.4 g/L), 32.37 g/L immunoglobulin (8-17 g/L), and 31568.1 mg/24 h total 24-h urine protein (0-150 mg/24 h). The patient was diagnosed with SLE involving the joints, kidneys and blood system. Previously reported cases of SLE were retrieved from PubMed to characterize clinicopathological features and identify prognostic factors for SLE.

CONCLUSION

The patient was discharged in remission after a series of treatments, such as intravenous methylprednisolone sodium succinate, intravenous human immunoglobulin, cyclophosphamide injection, and plasma exchange. After discharge, the patient took oral prednisone acetate tablets, cyclosporine capsules, hydroxychloroquine sulfate tablets and other treatments for symptoms and was followed up regularly for 1 month, after which the patient's condition continued to improve and stabilize.

Keywords: Plasma exchange, Autoimmune hemolytic anemia, Systemic lupus erythematosus, Ulcerative colitis, Case report

Core Tip: The association between ulcerative colitis (UC) and systemic lupus erythematosus (SLE) is a rare phenomenon. We first diagnosed a patient with coexisting UC and SLE with refractory autoimmune hemolytic anemia. Combined with the analysis of the cases indexed in PubMed, plasma exchange (PE) has been reported as a promising strategy for treating refractory autoimmune hemolytic anemia. The patient was successfully treated and maintained stable conditions through PE and continuous treatment with cyclophosphamide and hydroxychloroquine. Therefore, personalized treatment is currently the best approach.