Systemic lupus erythematosus complicated with pure red cell aplasia: a case report and literature review

doi:10.3969/j.issn.1674-8115.2024.02.015

Abstract

Abstract:

This article reports a single case of a patient with systemic lupus erythematosus (SLE) combined with pure red cell aplasia (PRCA), and reviews 51 additional cases of patients reported by domestic and overseas papers from 1974 to 2021. These 52 (51+1) cases were analyzed to summarize the epidemiological features, clinical features, laboratory inspections, treatments and prognosis of the patients. The results indicated that among all the 52 cases, cases of SLE combined with PRCA were mostly seen in Asian childbearing age women. The median ages of patients diagnosed with SLE and diagnosed with PRCA were 31.5 years and 36.0 years, respectively. The time interval between the initial diagnosis of SLE and subsequent diagnosis of PRCA was significantly longer than the interval for the initial diagnosis of PRCA, suggesting a delayed onset of SLE in these patients (P=0.042). Various clinical features of the 52 patients were reported, including mostly fatigue, joint pains, Raynaud phenomena and rashes, and SLE maybe combined with autoimmune hemolytic anemia (AIHA), thymoma, hypothyroidism and myasthenia gravis (MG). In these reported cases, laboratory indicators showed higher proportions of antinuclear antibody (ANA), anti double stranded DNA antibody (anti-dsDNA antibody), positive urinary protein and low complement levels. Among the 52 patients, 51 cases (98.08%) were treated with glucocorticoids, followed by blood transfusion, cyclosporin A, cyclophosphamide and high-dose intravenous immunoglobulin. Of the 50 patients whose prognoses were reported, 44 showed improvement, while 3 treatments were not effective and 3 resulted in death. This article aims to enhance the understanding of SLE combined with PRCA among doctors.

Key words: systematic lupus erythrematosus (SLE), pure red cell aplasic anemia (PRCA), epidemiological characteristic, clinical characteristic

CLC Number:

R593.24

CHEN Qiong, FANG Jie, WEI Qianghua. Systemic lupus erythematosus complicated with pure red cell aplasia: a case report and literature review[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(2): 278-286.

Figures/Tables 6

Fig 1 Process of disease change and treatment

Tab 1 Data of the 51 cases

First author	Published year	Origin of the case	Case sample/n	Gender	Age/year	Reference
ZHANG L	2005	China	1	F	6	[6]
ZHANG G C	1991	China	1	M	44	[7]
XIE Q B	2002	China	2	M/F	54/56	[8]
CHEN N N	2006	China	1	F	26	[9]
LIU G Q	2005	China	2	F/F	41/31	[10]
HUANG R W	1998	China	1	F	43	[11]
LIU W F	1999	China	1	F	21	[12]
LIU Y	2017	China	1	M	19	[13]
NI X	2011	China	1	F	37	[14]
MITSUNAKA H	1998	Japan	1	F	68	[15]
IWADATE H	2006	Japan	1	F	43	[16]
HABIB G S	2002	Iseral	1	F	31	[17]
LINARDAKI G D	1999	Greece	2	F/F	21/28	[18]
KOYAMA R V	2014	Brazil	1	F	52	[19]
CHOI B G	2002	Korea	1	F	31	[20]
DUCHMANN R	1995	Germany	1	F	63	[21]
FRANCIS D A	1982	UK	1	F	64	[22]
OKADA H	1994	Japan	1	M	43	[23]
MAVRAGANI C P	2003	Greece	1	F	38	[24]
KIELY P D	1995	India	2	F/F	22/33	[25]
ATZENI F	2003	Italy	1	F	50	[26]
DUARTE-SALAZAR C	2000	Mexico	1	F	21	[27]
CHAN A Y K	2005	Hongkong, China	1	F	59	[28]
IDEGUCHI H	2007	Japan	1	F	82	[29]
SUZUKI T	2003	Japan	1	F	54	[30]
GUPTA R K	2011	Vietnam	1	F	23	[31]
FRANZÉN P	1987	Finland	1	F	24	[32]
HECK L W	1985	USA	1	F	17	[33]
HARA A	2008	Japan	1	F	42	[34]
MARMONT A M	2014	Italy	1	F	45	[35]
MEYER R J	1978	China	1	F	56	[36]
FALLAHI S	2014	Iran	1	F	54	[37]
ARCASOY M O	2005	USA	1	F	34	[38]
MOLLAEIAN A	2020	African	1	M	65	[39]
BISWAL N	2007	India	1	F	9	[40]
NAKAMURA H	2010	Japan	1	F	47	[41]
ILAN Y	1993	Iseral	1	F	22	[42]
TAKIGAWA M	1974	Japan	1	F	44	[43]
HARADA N	1990	Japan	1	F	27	[44]
ATSUMI T	1991	Japan	1	M	21	[45]
JAREK M J	1996	USA	1	F	69	[46]
MINAMI R	2006	Japan	1	F	33	[47]
MURAYAMA J	2006	Japan	1	F	48	[48]
SAEED M	2021	Pakistan	1	F	27	[49]
TOMAC-STOJMENOVIĆ M	2017	Croatia	1	F	35	[50]
DU A X	2006	Taiwan, China	1	F	24	[51]
JIMENO S A	2001	Spain	1	F	19	[52]

Fig 2 Regional distribution of cases (left) and age distribution of female patients (right)

Tab 2 Characteristics of patients diagnosed with SLE/PRCA

Demographic data	Number of patient/n (%)	Age/year	Interval between two diagnoses/year
Diagnosed as SLE first	22 (43.71)	35.77 $±$ 14.19	6.95 $±$ 5.64^①
Diagnosed as PRCA first	12 (23.08)	30.83 $±$ 16.24	3.22 $±$ 2.92
Diagnosed as SLE and PRCA simultaneously	18 (34.62)	37.22 $±$ 16.51	0

Tab 2 Characteristics of patients diagnosed with SLE/PRCA

Demographic data	Number of patient/n (%)	Age/year	Interval between two diagnoses/year
Diagnosed as SLE first	22 (43.71)	35.77 $±$ 14.19	6.95 $±$ 5.64^①
Diagnosed as PRCA first	12 (23.08)	30.83 $±$ 16.24	3.22 $±$ 2.92
Diagnosed as SLE and PRCA simultaneously	18 (34.62)	37.22 $±$ 16.51	0

Tab 3 Laboratory indicators

Laboratory indicator	Positive case/ reported case/n	Positive rate/%
ANA	47/47	100.00
Anti-dsDNA antibody	38/43	88.37
Hypocomplementemia	32/39	82.05
Urinary protein	23/33	69.69
ACA	10/20	50.00
Anti-Sm antibody	7/18	38.89

Tab 4 Treatment measures

Treatment	Number of patient/n (%)
GC	51 (98.08)
BT	34 (65.38)
CsA	13 (25.00)
IVIG	9 (17.31)
CTX	9 (17.31)
HCQ	8 (15.38)
EPO	5 (9.62)
AZA	5 (9.62)
MMF	2 (3.85)
PE	2 (3.85)
RTX	2 (3.85)
MTX	1 (1.92)

TrendMD

References 53

1	CHAKRAVARTY E F, BUSH T M, MANZI S, et al. Prevalence of adult systemic lupus erythematosus in California and Pennsylvania in 2000: estimates obtained using hospitalization data[J]. Arthritis Rheum, 2007, 56(6): 2092-2094.
2	PONS-ESTEL G J, ALARCÓN G S, SCOFIELD L, et al. Understanding the epidemiology and progression of systemic lupus erythematosus[J]. Semin Arthritis Rheum, 2010, 39(4): 257-268.
3	IZMIRLY P M, PARTON H, WANG L, et al. Prevalence of systemic lupus erythematosus in the United States: estimates from a meta-analysis of the centers for disease control and prevention national lupus registries[J]. Arthritis Rheumatol, 2021, 73(6): 991-996.
4	STOJAN G, PETRI M. Epidemiology of systemic lupus erythematosus: an update[J]. Curr Opin Rheumatol, 2018, 30(2): 144-150.
5	中华医学会血液学分会红细胞疾病(贫血)学组. 获得性纯红细胞再生障碍诊断与治疗中国专家共识(2020年版)[J]. 中华血液学杂志, 2020, 41(3): 177-184.
	Red Blood Cell Disease (Anemia) Group, Chinese Society of Hematology, Chinese Medical Association. Chinese expert consensus on the diagnosis and treatment of acquired pure red cell aplasia (2020)[J]. Chinese Journal of Hematology, 2020, 41(3): 177-184.
6	张丽, 邹尧, 陈玉梅, 等. 儿童系统性红斑狼疮相关纯红细胞再生障碍性贫血1例报告并文献复习[J]. 中国实用儿科杂志, 2005, 20(7): 436-438.
	ZHANG L, ZOU Y, CHEN Y M, et al. Pure red cell aplasia as presentation of systemic lupus erythematosus in children[J]. Chinese Journal of Practical Pediatrics, 2005, 20(7): 436-438.
7	张国材. 继发于系统性红斑性狼疮的纯红细胞性再生障碍性贫血1例报告[J]. 新医学, 1991, 22(4): 187.
	ZHANG G C. A case report of pure red blood cell aplastic anemia secondary to systemic lupus erythematosus[J]. Journal of New Medicine, 1991, 22(4): 187.
8	谢其冰, 杨南萍, 罗泽玲. 系统性红斑狼疮伴纯红细胞再生障碍性贫血2例[J]. 实用医学杂志, 2002, 18(8): 865.
	XIE Q B, YANG N P, LUO Z L, et al. Two cases of systemic lupus erythematosus with pure red blood cell aplastic anemia[J]. The Journal of Practical Medicine, 2002, 18(8): 865.
9	陈楠楠, 黄世林, 向阳, 等. 系统性红斑狼疮并发纯红细胞再生障碍性贫血[J]. 临床皮肤科杂志, 2006, 35(8): 536.
	CHEN N N, HUANG S L, XIANG Y, et al. Systemic lupus erythematosus complicated with pure red blood cell aplastic anemia[J]. Journal of Clinical Dermatology, 2006, 35(8): 536.
10	刘国强. 系统性红斑狼疮并发纯红细胞再生障碍性贫血2例[J]. 中国实用内科杂志, 2005, 25(10): 958.
	LIU G Q. Two cases of systemic lupus erythematosus complicated with pure red blood cell aplastic anemia[J]. Chinese Journal of Practical Internal Medicine, 2005, 25(10): 958.
11	黄仁魏, 夏忠军, 吴祥元, 等. 以纯红细胞再生障碍性贫血为首发表现的系统性红斑狼疮1例[J]. 中国实用内科杂志, 1998, 18(9): 551.
	HUANG R W, XIA Z J, WU X Y, et al. A case of systemic lupus erythematosus with pure red blood cell aplastic anemia as the initial manifestation[J]. Chinese Journal of Practical Internal Medicine, 1998, 18(9): 551.
12	刘维凤, 吴恩亮. 以纯红细胞再生障碍性贫血为首发症状的系统性红斑狼疮1例[J]. 滨州医学院学报, 1999, 22(6): 620.
	LIU W F, WU E L. A case of systemic lupus erythematosus with pure red blood cell aplastic anemia as the initial symptom[J]. Journal of Binzhou Medical University, 1999, 22(6): 620.
13	刘艳, 高华, 任虹蓉, 等. 重症系统性红斑狼疮合并纯红细胞再生障碍性贫血1例[J]. 武警后勤学院学报(医学版), 2017, 26(9): 823-824.
	LIU Y, GAO H, REN H R, et al. A case of severe systemic lupus erythematosus complicated with pure red blood cell aplastic anemia[J]. Journal of Logistics University of PAP (Medical Sciences), 2017, 26(9): 823-824.
14	倪勋, 魏锦, 罗文丰. 系统性红斑狼疮继发纯红细胞再生障碍一例[J]. 华西医学, 2011, 26(8): 1211-1212.
	NI X, WEI J, LUO W F. A case of secondary pure red blood cell regeneration disorder in systemic lupus erythematosus[J]. West China Medical Journal, 2011, 26(8): 1211-1212.
15	MITSUNAKA H, TOKUDA M, TAKAHARA J, et al. A case of systemic lupus erythematosus with pure red cell aplasia possibly caused by persistent infection of human parvovirus B19[J]. Nihon Rinsho Meneki Gakkai Kaishi, 1998, 21(5): 220-225.
16	IWADATE H, KOBAYASHI H, SHIO K, et al. A case of systemic lupus erythematosus complicated by pure red cell aplasia and idiopathic portal hypertension after thymectomy[J]. Mod Rheumatol, 2006, 16(2): 109-112.
17	HABIB G S, SALIBA W R, FROOM P. Pure red cell aplasia and lupus[J]. Semin Arthritis Rheum, 2002, 31(4): 279-283.
18	LINARDAKI G D, BOKI K A, FERTAKIS A, et al. Pure red cell aplasia as presentation of systemic lupus erythematosus: antibodies to erythropoietin[J]. Scand J Rheumatol, 1999, 28(3): 189-191.
19	KOYAMA R V, SILVA L F, HENRIQUES V B, et al. Pure red cell aplasia associated with systemic lupus erythematosus[J]. Acta Reumatol Port, 2014, 39(3): 265-268.
20	CHOI B G, YOO W H. Successful treatment of pure red cell aplasia with plasmapheresis in a patient with systemic lupus erythematosus[J]. Yonsei Med J, 2002, 43(2): 274-278.
21	DUCHMANN R, SCHWARTING A, PORALLA T, et al. Thymoma and pure red cell aplasia in a patient with systemic lupus erythematosus[J]. Scand J Rheumatol, 1995, 24(4): 251-254.
22	FRANCIS D A. Pure red-cell aplasia: association with systemic lupus erythematosus and primary autoimmune hypothyroidism[J]. Br Med J (Clin Res Ed), 1982, 284(6309): 85.
23	OKADA H, SUZUKI H, UCHIDA H, et al. Acquired idiopathic pure red cell aplasia in a hemodialyzed patient with inactive systemic lupus erythematosus[J]. Intern Med, 1994, 33(8): 492-495.
24	MAVRAGANI C P, VLACHAKI E, VOULGARELIS M. Pure red cell aplasia in a Sjögren's syndrome/lupus erythematosus overlap patient[J]. Am J Hematol, 2003, 72(4): 259-262.
25	KIELY P D, MCGUCKIN C P, COLLINS D A, et al. Erythrocyte aplasia and systemic lupus erythematosus[J]. Lupus, 1995, 4(5): 407-411.
26	ATZENI F, SARZI-PUTTINI P, CAPSONI F, et al. Successful treatment of pure red cell aplasia in systemic lupus erythematosus with cyclosporin A[J]. Clin Exp Rheumatol, 2003, 21(6): 759-762.
27	DUARTE-SALAZAR C, CAZARÍN-BARRIENTOS J, GOYCOCHEA-ROBLES M V, et al. Successful treatment of pure red cell aplasia associated with systemic lupus erythematosus with cyclosporin A[J]. Rheumatology (Oxford), 2000, 39(10): 1155-1157.
28	CHAN A Y K, LI E K, TAM L S, et al. Successful treatment of pure red cell aplasia associated with systemic lupus erythematosus with oral danazol and steroid[J]. Rheumatol Int, 2005, 25(5): 388-390.
29	IDEGUCHI H, OHNO S, ISHIGATSUBO Y. A case of pure red cell aplasia and systemic lupus erythematosus caused by human parvovirus B19 infection[J]. Rheumatol Int, 2007, 27(4): 411-414.
30	SUZUKI T, SAITO S, HIRABAYASHI Y, et al. Human parvovirus B19 infection during the inactive stage of systemic lupus erythematosus[J]. Intern Med, 2003, 42(6): 538-540.
31	GUPTA R K, EZEONYEJI A N, THOMAS A S, et al. A case of pure red cell aplasia and immune thrombocytopenia complicating systemic lupus erythematosus: response to rituximab and cyclophosphamide[J]. Lupus, 2011, 20(14): 1547-1550.
32	FRANZÉN P, FRIMAN C, PETTERSSON T, et al. Combined pure red cell aplasia and primary autoimmune hypothyroidism in systemic lupus erythematosus[J]. Arthritis Rheum, 1987, 30(7): 839-840.
33	HECK L W, ALARCÓN G S, BALL G V, et al. Pure red cell aplasia and protein-losing enteropathy in a patient with systemic lupus erythematosus[J]. Arthritis Rheum, 1985, 28(9): 1059-1061.
34	HARA A, WADA T, KITAJIMA S, et al. Combined pure red cell aplasia and autoimmune hemolytic anemia in systemic lupus erythematosus with anti-erythropoietin autoantibodies[J]. Am J Hematol, 2008, 83(9): 750-752.
35	MARMONT A M, BACIGALUPO A, GUALANDI F, et al. Systemic lupus erythematosus complicated with thymoma and pure red cell aplasia (PCRA). CR of both complications following thymectomy and allogeneic haematopoietic SCT (HSCT), but persistence of antinuclear antibodies (ANA)[J]. Bone Marrow Transplant, 2014, 49(7): 982-983.
36	MEYER R J, HOFFMAN R, ZANJANI E D. Autoimmune hemolytic anemia and periodic pure red cell aplasia in systemic lupus erythematosus[J]. Am J Med, 1978, 65(2): 342-345.
37	FALLAHI S, AKBARIAN M, DABIRI S. Pure red cell aplasia as a presenting feature in systemic lupus erythematosus and association with thymoma, hypothyroidism and hypoparathyroidism: a case report and literature review[J]. Iran J Allergy Asthma Immunol, 2014, 13(2): 138-143.
38	ARCASOY M O, CHAO N J. T-cell-mediated pure red-cell aplasia in systemic lupus erythematosus: response to cyclosporin A and mycophenolate mofetil[J]. Am J Hematol, 2005, 78(2): 161-163.
39	MOLLAEIAN A, HAAS C. A tale of autoimmunity: thymoma, thymectomy, and systemic lupus erythematosus[J]. Clin Rheumatol, 2020, 39(7): 2227-2234.
40	BISWAL N, NARAYANAN P, CHETAN G. Cyclosporine A responsive pure red cell aplasia in a child with systemic lupus erythematosus[J]. Indian J Hematol Blood Transfus, 2007, 23(3/4): 107-108.
41	NAKAMURA H, OKADA A, KAWAKAMI A, et al. Isoniazid-triggered pure red cell aplasia in systemic lupus erythematosus complicated with myasthenia gravis[J]. Rheumatol Int, 2010, 30(12): 1643-1645.
42	ILAN Y, NAPARSTEK Y. Pure red cell aplasia associated with systemic lupus erythematosus: remission after a single course of intravenous immunoglobulin[J]. Acta Haematol, 1993, 89(3): 152-154.
43	TAKIGAWA M, HAYAKAWA M. Thymoma with systemic lupus erythematosus, red blood cell aplasia, and herpesvirus infection[J]. Arch Dermatol, 1974, 110(1): 99-102.
44	HARADA N, NAGASAWA K, OKAMURA T, et al. A case of systemic lypus erythematosus with autoimmune hemolytic anemia amd with a history of pure red cell aplasia[J]. Jpn J Clin Immunol, 1990, 13(3): 286-291.
45	ATSUMI T, SAGAWA A, KATSUMATA K, et al. A case of systemic lupus erythematosus with pure red cell aplasia responded to steroid pulse therapy[J]. Jpn J Clin Immunol, 1991, 14(6): 639-645.
46	JAREK M J, ENZENAUER R J, JUDSON P H. Pure red cell aplasia in systemic lupus erythematosus[J]. J Clin Rheumatol, 1996, 2(1): 44-49.
47	MINAMI R, IZUTSU K, MIYAMURA T, et al. A case of systemic lupus erythematosus accompanied with pure red cell aplasia[J]. Nihon Rinsho Meneki Gakkai Kaishi, 2006, 29(3): 148-153.
48	MURAYAMA J, ASANUMA Y, TSUDA T, et al. Appearance of central nervous system lupus during corticosteroid therapy and warfarinization in a patient with pure red cell aplasia and antiphospholipid syndrome[J]. Nihon Rinsho Meneki Gakkai Kaishi, 2006, 29(1): 43-47.
49	SAEED M, SHARIF F, IJAZ M, et al. A case of systemic lupus erythematosus presenting as pure red cell aplasia[J]. Int J Hematol Oncol Stem Cell Res, 2021, 15(2): 135-138.
50	TOMAC-STOJMENOVIĆ M, HADŽISEJDIĆ I, VALKOVIĆ T, et al. Pure red blood cell aplasia in systemic lupus erythematosus: a case report[J]. Reumatizam, 2017, 64(1): 26-29.
51	杜安琇, 叶凤英, 高雅慧. Azathioprine引起的单纯红血球再生不良[J]. 台湾医学, 2006, 10(1): 42-48.
	DU A X, YE F Y, GAO Y H. Azathioprine-induced pure red blood cell aplasia[J]. Formosan Journal of Medicine, 2006, 10(1): 42-48.
52	JIMENO SAINZ A, BLÁZQUEZ ENCINAR J C, CONESA V. Pure red aplasia as the first manifestation of systemic lupus erythematosus[J]. Am J Med, 2001, 111(1): 78-79.
53	CHOI Y, JO J C, JEON H J, et al. Trend and treatment patterns of aplastic anemia in Korea, pure red cell aplasia and myelodysplastic syndrome in Korea: a nation-wide analysis[J]. Int J Hematol, 2017, 106(4): 500-507.

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