Anti-HLA Antibodies Complicating Infectious Mononucleosis with Thrombocytopenia and Neutropenia

A case concerning a 21-year-old male college student with thrombocytopenia and neutropenia complicating infectious mononucleosis is presented. Although the patient had no prior history of alloimmunization, a broad spectrum anti-HLA antibody was strongly positive in his serum. Concomitant with resolution of the hematologic abnormalities, the titer of the antibody diminished. This case is unique both in the severity of the thrombocytopenia and neutropenia and for the circulating HLA antibody most likely of viral origin

Dermatomyositis Complicated by Thrombotic Thrombocytopenic Purpura

A 65-year-old woman who had a documented history of dermatomyositis was hospitalized for evaluation of a syncopal attack. During the course of her stay, she experienced progressive neurologic dysfunction, hemolytic anemia, and thrombocytopenia. A clinical diagnosis of thrombotic thrombocytopenia purpura (TTP) was made, and therapy was initiated with glucocorticoids, plasmapheresis, plasma infusion, and antiplatelet medication. The pathogenesis of TTP has not been cleady elucidated. However, reports in the literature have postulated immune damage of the endothelium with demonstration of IgM and complement deposits as the origin of the condition. Further, there are reported cases of TTP associated with collagen disorders such as systemic lupus erythematosus, rheumatoid arthritis, polyarteritis nodosa, and Sjogren\u27s syndrome. To our knowledge, this represents the first known case of an association of TTP with dermatomyositis. Because of the implication of an immunologic pathogenesis for these disorders, this association is worth noting

Azathioprine-lnduced Reversible Severe Dyserythropoiesis as a Cause of Anemia

A 43-year-old woman with a 20-year history of systemic lupus erythematosus was treated with azathioprine for progressive complications of the disease. She developed pancytopenia within four weeks after starting azathioprine therapy. Bone marrow examination showed marked dyserythropoiesis and varying degrees of marrow hypoplasia. Changes seen in normoblasts consisted of nuclear buds, multinucleation, Howell-Jolly bodies, and abnormal mitoses. Azathioprine was discontinued. Peripheral blood counts improved in the next four weeks. A progress bone marrow examination six weeks later showed marked improvement in red blood cell abnormalities. An additional bone marrow examination performed four months after discontinuation of azathioprine showed complete disappearance of the dyspoietic changes in the red cell precursors despite continued clinical deterioration. Three patients who were treated with azathioprine to prevent transplant rejection showed similar dyspoietic changes in erythroid precursors associated with anemia