我们在这里报道了一名50岁的男性，他首次被诊断为骨髓增生异常综合征伴过度blast-2（MDS-EB-2），并于2019年接受了异基因造血干细胞移植（allo-HSCT），导致完全缓解。然而,他在2021年被诊断出患有多种自身免疫性疾病，包括自身免疫性肝炎（AIH），桥本甲状腺炎（HT），和自身免疫性溶血性贫血（AIHA）。这被称为多发性自身免疫综合征（MAS），这是allo-HSCT后罕见的情况，正如文献中先前提到的。尽管接受了糖皮质激素治疗，环孢菌素A,和其他药物，患者没有完全康复。为了解决糖皮质激素难治性MAS，利妥昔单抗（RTX）为期四周，每周剂量为100mg，这显著改善了患者的病情。因此，该病例报告强调了对移植后自身免疫性疾病患者实施替代治疗的重要性，糖皮质激素难治性或糖皮质激素依赖性患者，并强调了RTX作为二线治疗的有效性。
We report here the case of a 50-year-old man who was first diagnosed with myelodysplastic syndrome with excess blasts-2 (MDS-EB-2) and underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 2019, resulting in complete remission. However, he was diagnosed in 2021 with several autoimmune disorders, including autoimmune hepatitis (AIH), Hashimoto\'s thyroiditis (HT), and autoimmune hemolytic anemia (AIHA). This is referred as multiple autoimmune syndrome (MAS), which is a rare occurrence after allo-HSCT, as previously noted in the literature. Despite being treated with glucocorticoids, cyclosporine A, and other medications, the patient did not fully recover. To address the glucocorticoid-refractory MAS, a four-week course of rituximab (RTX) at a weekly dose of 100mg was administered, which significantly improved the patient\'s condition. Thus, this case report underscores the importance of implementing alternative treatments in patients with post-transplant autoimmune diseases, who are glucocorticoid-refractory or glucocorticoid-dependent, and highlights the effectiveness of RTX as second-line therapy.
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