Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant Patient
Autoimmune hemolytic anemia (AIHA) is a rare complication following heart transplantation and has been attributed to several etiologies including infections, immunosuppressive medications, and post-transplant lymphoproliferative disorders. We report a 23-year-old male presenting 22 years after heart...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Hematology Reports |
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| Online Access: | https://www.mdpi.com/2038-8330/14/3/36 |
| _version_ | 1797487697846075392 |
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| author | Dan Ran Castillo Parthiv Sheth Kevin Nishino Wesley Tait Stevens Anthony Nguyen Alberto Romagnolo Hamid Mirshahidi |
| author_facet | Dan Ran Castillo Parthiv Sheth Kevin Nishino Wesley Tait Stevens Anthony Nguyen Alberto Romagnolo Hamid Mirshahidi |
| author_sort | Dan Ran Castillo |
| collection | DOAJ |
| description | Autoimmune hemolytic anemia (AIHA) is a rare complication following heart transplantation and has been attributed to several etiologies including infections, immunosuppressive medications, and post-transplant lymphoproliferative disorders. We report a 23-year-old male presenting 22 years after heart transplantation with severe AIHA. Laboratory findings were notable for positive IgG autoantibody against RBCs and high titer Epstein-Barr virus (EBV) viremia. Shortly after the first unit of irradiated RBC transfusion and high dose steroids, the patient developed acute dyspnea and hypoxia requiring intubation. Further workup demonstrated that the patient had Methicillin-sensitive Staphylococcus aureus (MSSA) pneumonia (PNA) and bacteremia, requiring antibiotics. Patient was subsequently treated with high-dose steroids, IVIG, as well as rituximab. Following treatment, the patient was successfully extubated and eventually showed complete resolution of the anemia. This case is novel as it represents AIHA likely secondary to EBV viremia in a post-cardiac transplant patient complicated by a severe transfusion reaction. In this circumstance, rituximab in conjunction with standard of care remains an effective treatment of choice. |
| first_indexed | 2024-03-09T23:52:27Z |
| format | Article |
| id | doaj.art-40905d237d5f4a3288256dd7bea82939 |
| institution | Directory Open Access Journal |
| issn | 2038-8330 |
| language | English |
| last_indexed | 2024-03-09T23:52:27Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Hematology Reports |
| spelling | doaj.art-40905d237d5f4a3288256dd7bea829392023-11-23T16:31:43ZengMDPI AGHematology Reports2038-83302022-08-0114326126410.3390/hematolrep14030036Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant PatientDan Ran Castillo0Parthiv Sheth1Kevin Nishino2Wesley Tait Stevens3Anthony Nguyen4Alberto Romagnolo5Hamid Mirshahidi6Hematology/Oncology Department, Loma Linda University Medical Center, Loma Linda, CA 92354, USADepartment of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USADepartment of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USADepartment of Pathology, Loma Linda University Medical Center, Loma Linda, CA 92354, USAMoores Cancer Center, UCSD, San Diego, CA 92037, USAHematology/Oncology Department, Loma Linda University Medical Center, Loma Linda, CA 92354, USAHematology/Oncology Department, Loma Linda University Medical Center, Loma Linda, CA 92354, USAAutoimmune hemolytic anemia (AIHA) is a rare complication following heart transplantation and has been attributed to several etiologies including infections, immunosuppressive medications, and post-transplant lymphoproliferative disorders. We report a 23-year-old male presenting 22 years after heart transplantation with severe AIHA. Laboratory findings were notable for positive IgG autoantibody against RBCs and high titer Epstein-Barr virus (EBV) viremia. Shortly after the first unit of irradiated RBC transfusion and high dose steroids, the patient developed acute dyspnea and hypoxia requiring intubation. Further workup demonstrated that the patient had Methicillin-sensitive Staphylococcus aureus (MSSA) pneumonia (PNA) and bacteremia, requiring antibiotics. Patient was subsequently treated with high-dose steroids, IVIG, as well as rituximab. Following treatment, the patient was successfully extubated and eventually showed complete resolution of the anemia. This case is novel as it represents AIHA likely secondary to EBV viremia in a post-cardiac transplant patient complicated by a severe transfusion reaction. In this circumstance, rituximab in conjunction with standard of care remains an effective treatment of choice.https://www.mdpi.com/2038-8330/14/3/36EBVheart transplantationAIHArituximab |
| spellingShingle | Dan Ran Castillo Parthiv Sheth Kevin Nishino Wesley Tait Stevens Anthony Nguyen Alberto Romagnolo Hamid Mirshahidi Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant Patient Hematology Reports EBV heart transplantation AIHA rituximab |
| title | Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant Patient |
| title_full | Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant Patient |
| title_fullStr | Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant Patient |
| title_full_unstemmed | Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant Patient |
| title_short | Successful Treatment of Autoimmune Hemolytic Anemia Concomitant with Proliferation of Epstein-Barr Virus in a Post-Heart Transplant Patient |
| title_sort | successful treatment of autoimmune hemolytic anemia concomitant with proliferation of epstein barr virus in a post heart transplant patient |
| topic | EBV heart transplantation AIHA rituximab |
| url | https://www.mdpi.com/2038-8330/14/3/36 |
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