Cyclosporine A in the treatment of a patient with immune thrombocytopenia accompanied by myelodysplastic syndrome and nephrotic syndrome

Abstract

We describe a complete remission with cyclosporine A in a myelodysplastic syndrome (MDS) patient who had a 9-year history of nephrotic syndrome (NS) due to autoimmune nephritis. A 72-year-old woman with MDS and NS rapidly developed thrombocytopenia with multiple spontaneous bleeding episodes and profound proteinuria. She showed persistent platelet refractoriness to platelet transfusions. A flow cytometry examination strongly detected antiplatelet autoantibodies on the surface of her platelets. The treatment with high-dose corticosteroids and intravenous immunoglobulin did not lead to complete improvement in the platelet count, bleedings and proteinuria. However, a low dose of cyclosporine A resulted in a sustained normal range of blood platelet count and negative proteinuria. This finding suggests that, in selected cases, cyclosporine A can be an attractive alternative for MDS patients who also have immune-mediated diseases.