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Case Report
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Year 2024, Volume: 3 Issue: 2, 86 - 89, 28.06.2024

Abstract

References

  • 1. Xu L, Zhang Y, Lin N, Song X, Dai Q. Eltrombopag improves refractory thrombocytopenia in patients with Sjögren’s syndrome. Sci Prog. 2022;105(2). https// doi: 10.1177/00368504221102786
  • 2. Altenburg J, De Graaff CS, Van Der Werf TS, Boersma WG. Immunomodulatory effects of macrolide antibiotics–part 1: biological mechanisms. Respiration. 2010 Dec 1;81(1):67-74. https://doi: 10.1159/000320319
  • 3. Ohe M, Hashino S. Successful treatment with erythromycin for idiopathic thrombocytopenic purpura. Korean J Hematol. 2011; 46:139-142. https://doi:10.5045/kjh.2011.46.2.139
  • 4. Ohe M, Hashino S. Successful treatment of primary immune thrombocytopenia in aged patients using clarithromycin. J Formos Med Assoc. 2014; 113:197-198. https://doi:10.1016/j.jfma.2011.08.035
  • 5. Ohe M, Furuya K, Goudarzi H. Immune Thrombocytopenia Treated with Intravenous Erythromycin. Gazi Med J. 2021 Sep 9;32(4):577-579. https://doi: 10.12996/gmj.2021.129
  • 6. Xu R, Yan Q, Gong Y, et al. Tacrolimus therapy in primary Sjögren’s syndrome with refractory immune thrombocytopenia: a retrospective study. Clin Exp Rheumatol. 2022 Dec;40(12):2268-2274. https://doi: 10.55563/clinexprheumatol/5c7l01. Epub 2022 Sep 20. PMID: 36135951.
  • 7. Du Y, Yang C, Chen M, et al. Tacrolimus is effective in relapsed/refractory autoimmune cytopenias: results of a single-center retrospective study. Hematology. 2020 Jan 1;25(1):478-483. https://doi: 10.1080/16078454.2020.1852763
  • 8. Ohe M. A Case of Rheumatoid Arthritis accompanied by Organizing Pneumonia Successfully Treated with Prednisolone, Clarithromycin and Tacrolimus. Korean J Clin Pharm. 2017 Sep 30;27(3):195-197. https://doi: 10.24304/kjcp.2017.27.3.195
  • 9. Suzuki K, Kameda H, Amano K, et al. Single center prospective study of tacrolimus efficacy and safety in treatment of rheumatoid arthritis. Rheumatol Int. 2009 Feb;29(4):431-436. https://doi: 10.1007/s00296-008-0833-z. Epub 2009 Jan 7. PMID: 19127365.

Add-on Erythromycin and Tacrolimus Treatment for Primary Sjogren’s Syndrome-Related Immune Thrombocytopenia: A Case Report

Year 2024, Volume: 3 Issue: 2, 86 - 89, 28.06.2024

Abstract

A 64-year-old woman with primary Sjogren’s syndrome (SjS) was admitted to our hospital for nasal bleeding, oral bleeding, and purpura on her entire body. On this admission, laboratory findings were as follows: white blood cell counts, 8,910 /μL; hemoglobin, 9.9 g/dL; and platelet (PLT) counts, 0.1×104/μL. Although the anti-PLT antibodies were positive, other autoimmune antibodies including anti-deoxyribonucleic acid antibodies were negative. No immunoglobulin (Ig)M antibodies for cytomegalovirus and Parvovirus B19, and no IgG antibodies for Helicobacter pylori, were detected. No abnormal findings suggestive of infection were identified in the systemic examination. A bone marrow aspiration smear revealed normal bone marrow. Based on these findings, the patient was diagnosed with primary SjS-related immune thrombocytopenia (ITP). The patient initially received intravenous immunoglobulin, methyl prednisolone (PSL) pulse therapy, and subsequent high dose PSL without significant improvement. Therefore, eltrombopag was added. Subsequently, erythromycin (EM) was also added, considering its immunomodulatory effects. After initiating the EM treatment, the PLT counts increased. Therefore, the PSL dosage was reduced. However, the PLT counts gradually decreased. Instead of increasing the PSL dosage again, tacrolimus (TAC) was successfully added. Consequently, the PSL dosage could be successfully reduced. This case suggests that EM and TAC can be effective alternatives when conventional immunosuppressants fail to improve primary SjS-related ITP.

References

  • 1. Xu L, Zhang Y, Lin N, Song X, Dai Q. Eltrombopag improves refractory thrombocytopenia in patients with Sjögren’s syndrome. Sci Prog. 2022;105(2). https// doi: 10.1177/00368504221102786
  • 2. Altenburg J, De Graaff CS, Van Der Werf TS, Boersma WG. Immunomodulatory effects of macrolide antibiotics–part 1: biological mechanisms. Respiration. 2010 Dec 1;81(1):67-74. https://doi: 10.1159/000320319
  • 3. Ohe M, Hashino S. Successful treatment with erythromycin for idiopathic thrombocytopenic purpura. Korean J Hematol. 2011; 46:139-142. https://doi:10.5045/kjh.2011.46.2.139
  • 4. Ohe M, Hashino S. Successful treatment of primary immune thrombocytopenia in aged patients using clarithromycin. J Formos Med Assoc. 2014; 113:197-198. https://doi:10.1016/j.jfma.2011.08.035
  • 5. Ohe M, Furuya K, Goudarzi H. Immune Thrombocytopenia Treated with Intravenous Erythromycin. Gazi Med J. 2021 Sep 9;32(4):577-579. https://doi: 10.12996/gmj.2021.129
  • 6. Xu R, Yan Q, Gong Y, et al. Tacrolimus therapy in primary Sjögren’s syndrome with refractory immune thrombocytopenia: a retrospective study. Clin Exp Rheumatol. 2022 Dec;40(12):2268-2274. https://doi: 10.55563/clinexprheumatol/5c7l01. Epub 2022 Sep 20. PMID: 36135951.
  • 7. Du Y, Yang C, Chen M, et al. Tacrolimus is effective in relapsed/refractory autoimmune cytopenias: results of a single-center retrospective study. Hematology. 2020 Jan 1;25(1):478-483. https://doi: 10.1080/16078454.2020.1852763
  • 8. Ohe M. A Case of Rheumatoid Arthritis accompanied by Organizing Pneumonia Successfully Treated with Prednisolone, Clarithromycin and Tacrolimus. Korean J Clin Pharm. 2017 Sep 30;27(3):195-197. https://doi: 10.24304/kjcp.2017.27.3.195
  • 9. Suzuki K, Kameda H, Amano K, et al. Single center prospective study of tacrolimus efficacy and safety in treatment of rheumatoid arthritis. Rheumatol Int. 2009 Feb;29(4):431-436. https://doi: 10.1007/s00296-008-0833-z. Epub 2009 Jan 7. PMID: 19127365.
There are 9 citations in total.

Details

Primary Language English
Subjects Traditional, Complementary and Integrative Medicine (Other)
Journal Section Case Report
Authors

Masashi Ohe 0000-0002-6684-6688

Publication Date June 28, 2024
Submission Date April 27, 2024
Acceptance Date June 25, 2024
Published in Issue Year 2024 Volume: 3 Issue: 2

Cite

EndNote Ohe M (June 1, 2024) Add-on Erythromycin and Tacrolimus Treatment for Primary Sjogren’s Syndrome-Related Immune Thrombocytopenia: A Case Report. ACH Medical Journal 3 2 86–89.