Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature review
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation. In recent decades, biological agents such as anti-tumor necrosis factor-α (TNF-α) drugs have been applied in the treatment of RA and it achieved great improvement. The treatment has its side e...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-10-01
|
| Series: | Frontiers in Pharmacology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.1041884/full |
| _version_ | 1797985890121809920 |
|---|---|
| author | Tiantian Liao Mengqing Li Tian Yuan Qifu Hong Yu Zeng Dan Yu Qiong Yu Limei Yu Limei Yu Tao Pu |
| author_facet | Tiantian Liao Mengqing Li Tian Yuan Qifu Hong Yu Zeng Dan Yu Qiong Yu Limei Yu Limei Yu Tao Pu |
| author_sort | Tiantian Liao |
| collection | DOAJ |
| description | Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation. In recent decades, biological agents such as anti-tumor necrosis factor-α (TNF-α) drugs have been applied in the treatment of RA and it achieved great improvement. The treatment has its side effects, but severe thrombocytopenia is very rare. In this case report we described the occurrence of severe thrombocytopenia in a patient with RA who was treated with adalimumab. Specially, the symptoms of the RA are not significantly improved by adalimumab treatment and severe thrombocytopenia it induced is resistant to treatment. After receiving four doses of adalimumab, the patient’s platelet count dropped to 4 × 103/μl. We halted adalimumab and administered glucocorticoids, interleukins, and platelet transfusion. On the sixth day, the platelet count rose to 52 × 103/μl. Lab tests and bone marrow pictures were unremarkable. Patient was treated with prednisone for maintenance. On day 17, the platelet count declined to 12 × 103/μl. We started the patient on methylprednisolone and recombinant human thrombopoietin (rh-TPO), but the effect was not significant. On day 25, intravenous immune globulin (IVIG) was applied in place of the rh-TPO. On 29th day, the patient’s platelets returned to normal. We summarized the existing literature on thrombocytopenia induced by anti-TNF-α drugs. This case suggested immunoglobulins could be considered for the treatment of refractory thrombocytopenia. |
| first_indexed | 2024-04-11T07:24:35Z |
| format | Article |
| id | doaj.art-a69e861e013840e3b0ff166ae96cfaa9 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-11T07:24:35Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-a69e861e013840e3b0ff166ae96cfaa92022-12-22T04:37:06ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-10-011310.3389/fphar.2022.10418841041884Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature reviewTiantian Liao0Mengqing Li1Tian Yuan2Qifu Hong3Yu Zeng4Dan Yu5Qiong Yu6Limei Yu7Limei Yu8Tao Pu9Department of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaDepartment of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaDepartment of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaDepartment of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaDepartment of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaDepartment of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaDepartment of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaKey Laboratory of Cell Engineering, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaThe Team of Scientific and Technological Innovation Talents on The Basic and Clinical Research of Amniotic Membrane and Bone Marrow Stem Cells, Zunyi, ChinaDepartment of Nephrology, The Affiliated Hospital of Zunyi Medical University, Zunyi, ChinaRheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation. In recent decades, biological agents such as anti-tumor necrosis factor-α (TNF-α) drugs have been applied in the treatment of RA and it achieved great improvement. The treatment has its side effects, but severe thrombocytopenia is very rare. In this case report we described the occurrence of severe thrombocytopenia in a patient with RA who was treated with adalimumab. Specially, the symptoms of the RA are not significantly improved by adalimumab treatment and severe thrombocytopenia it induced is resistant to treatment. After receiving four doses of adalimumab, the patient’s platelet count dropped to 4 × 103/μl. We halted adalimumab and administered glucocorticoids, interleukins, and platelet transfusion. On the sixth day, the platelet count rose to 52 × 103/μl. Lab tests and bone marrow pictures were unremarkable. Patient was treated with prednisone for maintenance. On day 17, the platelet count declined to 12 × 103/μl. We started the patient on methylprednisolone and recombinant human thrombopoietin (rh-TPO), but the effect was not significant. On day 25, intravenous immune globulin (IVIG) was applied in place of the rh-TPO. On 29th day, the patient’s platelets returned to normal. We summarized the existing literature on thrombocytopenia induced by anti-TNF-α drugs. This case suggested immunoglobulins could be considered for the treatment of refractory thrombocytopenia.https://www.frontiersin.org/articles/10.3389/fphar.2022.1041884/fullrheumatoid arthritisadalimumabthrombocytopeniacomplicationbiologic therapy |
| spellingShingle | Tiantian Liao Mengqing Li Tian Yuan Qifu Hong Yu Zeng Dan Yu Qiong Yu Limei Yu Limei Yu Tao Pu Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature review Frontiers in Pharmacology rheumatoid arthritis adalimumab thrombocytopenia complication biologic therapy |
| title | Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature review |
| title_full | Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature review |
| title_fullStr | Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature review |
| title_full_unstemmed | Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature review |
| title_short | Case Report: Severe thrombocytopenia induced by adalimumab in rheumatoid arthritis: A case report and literature review |
| title_sort | case report severe thrombocytopenia induced by adalimumab in rheumatoid arthritis a case report and literature review |
| topic | rheumatoid arthritis adalimumab thrombocytopenia complication biologic therapy |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.1041884/full |
| work_keys_str_mv | AT tiantianliao casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT mengqingli casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT tianyuan casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT qifuhong casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT yuzeng casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT danyu casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT qiongyu casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT limeiyu casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT limeiyu casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview AT taopu casereportseverethrombocytopeniainducedbyadalimumabinrheumatoidarthritisacasereportandliteraturereview |