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Two cases of refractory thrombotic thrombocytopenic purpura associated with collagen vascular disease were significantly improved by rituximab treatment

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Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare disorder of small vessels. TTP is associated with deficiency of the von Willebrand factor-cleaving protease, ADAMTS13, and its inhibitor. Low ADAMTS13 activity is present in most of idiopathic TTP patients. The prognosis of TTP was improved by plasma exchange treatment, which replaces the ADAMTS13 and removes ADAMTS13 inhibitor. However, ADAMTS13 activity is normal in some TTP patients. These are found among the secondary TTP patients associated with collagen disease, hematopoietic stem cell transplantation, malignancy, or drugs. In addition, most of them do not respond to plasma exchange. On the other hand, several reports demonstrated that rituximab, which is an anti-CD20 monoclonal antibody, is effective for refractory TTP cases caused by ADAMTS13 deficiency. It is considered that the effect of rituximab is associated with disappearance of ADAMTS13 inhibitor. However, rituximab therapy was effective for the TTP patients with normal ADAMTS13 activity in our cases. We considered another mechanism of rituximab for TTP cases.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Tomohiro Kameda, Hiroaki Dobashi, Katsuharu Kittaka, Kentaro Susaki & Toshihiko Ishida

  2. Department of Clinical Laboratory, Kagawa University Hospital, Kagawa, Japan

    Genji Yamaoka & Ken Arai

  3. Sanuki Municipal Hospital, Sanuki, Japan

    Michiaki Tokuda

Authors
  1. Tomohiro Kameda
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  2. Hiroaki Dobashi
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  3. Katsuharu Kittaka
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  4. Kentaro Susaki
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  5. Genji Yamaoka
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  6. Ken Arai
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  7. Michiaki Tokuda
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  8. Toshihiko Ishida
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Corresponding author

Correspondence to Hiroaki Dobashi.

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Kameda, T., Dobashi, H., Kittaka, K. et al. Two cases of refractory thrombotic thrombocytopenic purpura associated with collagen vascular disease were significantly improved by rituximab treatment. Clin Rheumatol 26, 2159–2162 (2007). https://doi.org/10.1007/s10067-007-0631-0

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  • DOI: https://doi.org/10.1007/s10067-007-0631-0

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