继发性冷凝集素自身免疫性溶血性贫血(AIHA)最常见于感染性原因,如支原体肺炎和,很少,EB病毒(EBV)。这里我们介绍一个69岁的女性,表现为全身无力,被发现患有冷凝集素溶血性贫血。不幸的是,她经历了一些最严重的并发症,包括脑病,缺氧,周围四肢干性坏死。进一步调查发现有EBV感染,感冒AIHA最罕见的传染性原因。她开始服用类固醇,治疗的主体,但在重症监护病房(ICU)的长期住院期间继续恶化。鉴于疾病的严重程度,决定使用血浆置换和利妥昔单抗,针对CD20的单克隆抗体,作为一种实验性疗法。辅助治疗开始后,患者开始临床好转,最终完全康复。利妥昔单抗在历史上仅在原发性感冒AIHA中有效,但我们在继发性感冒AIHA中的使用似乎引起了显著的临床改善.虽然有少数研究证明其在继发性感冒AIHA中的成功使用,我们建议进一步研究这种药物,以防止与该疾病相关的显著发病率和死亡率。
Secondary cold agglutinin autoimmune hemolytic anemia (AIHA) occurs most commonly due to infectious causes like Mycoplasma pneumonia and, more rarely, Epstein-Barr virus(EBV). Here we present a case of a 69-year-old female presenting with generalized weakness, who was found to have cold agglutinin hemolytic anemia. She unfortunately experienced some of the most severe complications of the disease including encephalopathy, hypoxia, and dry necrosis of peripheral extremities. Further investigation revealed an EBV infection, the rarest infectious cause of cold AIHA. She was started on steroids, the mainstay of treatment, but continued to worsen over the course of her extensive stay in the intensive care unit (ICU). Given the severity of the disease, the decision was made to use plasmapheresis and rituximab, the monoclonal antibody directed against CD20, as an experimental therapy. After adjunctive therapy was initiated, the patient began to clinically improve and ultimately made a full recovery. Rituximab is historically only effective in primary cold AIHA, but it appeared to elicit significant clinical improvement with our use in secondary cold AIHA. While there have been a handful of studies demonstrating its successful use in secondary cold AIHA, we propose that this medication be further studied to prevent the significant morbidity and mortality associated with the disease.