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Case Report
Rituximab Treatment of Thrombotic Thrombocytopenic Purpura in the Setting of Connective Tissue Disease
TIMOTHY B. NIEWOLD, DEBORAH ALPERT, CARLA R. SCANZELLO, and STEPHEN A. PAGET ABSTRACT. Thrombotic thrombocytopenic purpura (TTP) causes significant morbidity and mortality, and may be associated with connective tissue diseases (CTD). Some cases are refractory to plasma exchange and require immunosuppressive therapy. We describe 2 patients with CTD who had refractory TTP treated successfully with rituximab. Both patients also developed heparin-induced thrombocytopenia (HIT). The propensity of a patient with a CTD to develop autoantibodies to ADAMTS-13 and platelets likely explains the association of such a disease with TTP and HIT. Rituximab should be considered in this complex clinical setting, because it may decrease the production of multiple pathogenic autoantibodies. (J Rheumatol 2006;33:1194–6) Key Indexing Terms:
THROMBOTIC THROMOBOCYTOPENIC PURPURA
From the Department of Rheumatology, Hospital for Special Surgery, New York, New York. T.B. Niewold, MD; D. Alpert, MD, PhD; C.R. Scanzello, MD, PhD; S.A. Paget, MD, FACP, FACR. Address reprint requests to Dr. S.A. Paget, MD, Department of Rheumatology, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021. Accepted for publication February 13, 2006.
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