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    Autoimmune haemolytic anaemia associated with Epstein Barr virus infection as a severe late complication after kidney transplantation and successful treatment with rituximab: case report

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    URI
    http://hdl.handle.net/11287/594008
    Author
    Hamilton, Alexander J.
    Webb, Lynsey H.
    Williams, Jennifer K.
    D'Souza, Richard J.
    Ngu, Loretta S.
    Moore, Jason
    Date
    2015-07-18
    Journal
    BMC nephrology
    Type
    Journal Article
    Publisher
    BioMed Central
    DOI
    10.1186/s12882-015-0096-3
    Metadata
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    Abstract
    BACKGROUND: Autoimmune haemolytic anaemia (AIHA) is a rare complication following kidney transplantation and usually occurs early in its course. It is characterised by autoantibodies or alloantibodies directed against red blood cells (RBCs). CASE PRESENTATION: We describe a 44 year old woman who presented 5 years after kidney transplantation with profound transfusion dependent warm AIHA. Investigations confirmed an IgG autoantibody against RBCs and high titre Epstein-Barr virus (EBV) viraemia. The patient was at higher risk for EBV disease being seronegative at the time of transplantation but had detectable EBV capsid IgG antibody at the time of presentation. The haemolysis was refractory to high dose steroid and intravenous immunoglobulin. There was a rapid and complete resolution of both the anaemia and the viraemia following rituximab therapy, with no adverse events. Twenty-six units of blood were required during the course of treatment. CONCLUSIONS: To our knowledge this is the first reported case of EBV associated AIHA in a renal transplant recipient. It highlights a rare pathology associated with post-transplant EBV infection, of broad interest to transplant physicians, haematologists, and microbiologists, and the effective novel use of monoclonal anti-CD20 therapy.
    Citation
    BMC Nephrol. 2015 Jul 18;16:108.
    Publisher URL
    http://www.biomedcentral.com/1471-2369/16/108
    Note
    This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
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    • 2015 RD&E publications
    • Exeter Kidney Unit (Renal)

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