Mycophenolate mofetil in the treatment of autoimmune HCV-associated haematological disorders showing steroid resistance or dependence |
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Authors: | Ierardi E Rendina M Francavilla R Barone M Castellaneta A Panella C Francavilla A Cuomo R |
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Affiliation: | Chair of Gastrenterology, University of Foggia, Foggia,;Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari,;Department of Paediatrics, University of Bari, Bari and;Hepatogastroenterology Unit, Department of Clinical and Experimental Medicine, 'Federico II' University of Naples, Naples, Italy |
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Abstract: | Summary. We report two cases of hepatitis C virus (HCV) associated autoimmune haematological disorders successfully treated with an unusual protocol (mycophenolate mofetil: MMF). The first case was a male patient with chronic HCV infection who developed, during interferon (IFN)/ribavirin therapy, severe autoimmune thrombocytopenia unresponsive to steroids. MMF was then administered and, simultaneously, the steroid dose was gradually reduced until withdrawal. Following this strategy, a progressive increase in platelet count and complete negativity of anti-PLT antibodies were achieved without changes in HCV-RNA quantitative determination. The second case was a woman with HCV liver cirrhosis with severe anaemia and Coombs test positivity partially responsive to continuous administration of steroid high doses. However, this treatment unmasked a severely painful vertebral osteoporosis. For this reason we introduced MMF and simultaneously steroid therapy was progressively reduced until withdrawal. Haemoglobin reached a normal value and the Coombs test became negative within 60 days. These case reports suggest that MMF may represent an interesting therapeutic approach for autoimmune HCV associated haematological disorders. |
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Keywords: | hepatitis C virus thrombocytopenia haemolytic anemia mycophenolate mofetil autoimmune disorders immunosuppressive drugs |
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