Case Report

Rituximab Treatment for Resistant Antiphospholipid Syndrome

ELYSE RUBENSTEIN, DANIEL G. ARKFELD, SAMY METYAS, SHUNTARO SHINADA, SONYA EHRESMANN, and HOWARD A. LIEBMAN

ABSTRACT.

Antiphospholipid syndrome (APS) and catastrophic antiphospholipid syndrome (CAPS) can be challenging to treat. As they are rare, clinicians are not often exposed to these complex diseases. For the patient resistant to standard treatments new therapeutic directions can be perplexing, especially in the context of ongoing thromboses and bleeding episodes. We describe 3 patients, 2 with APS and one with CAPS, resistant to conventional medications, who responded to treatment with rituximab, an anti-CD20 monoclonal antibody. Since rituximab infusion, all the patients have had stable platelet counts and no further episodes of bleeding or thromboses. (J Rheumatol 2006;33:355-7)

Key Indexing Terms:

ANTICARDIOLIPIN ANTIBODIES
CATASTROPHIC ANTICARDIOLIPIN ANTIBODIES
RITUXIMAB
DEEP VEIN THROMBOSIS
THROMBOCYTOPENIA
ANTIPHOSPHOLIPID SYNDROME

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From the Division of Rheumatology and Division of Hematology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

E. Rubenstein, MD, Rheumatology Fellow; D.G. Arkfeld, MD, Assistant Professor of Medicine; S. Metyas, MD, Assistant Professor of Medicine; S. Shinada, MD, Rheumatology Fellow; S. Ehresmann, Medical Student, Division of Rheumatology; H.A. Liebman, MD, Associate Professor of Medicine and Pathology, Division of Hematology.

Address reprint requests to Dr. D.G. Arkfeld, Division of Rheumatology, Keck School of Medicine, 2011 Zonal Avenue, HMR 711, Los Angeles, CA 90033. E-mail: arkfeld@usc.edu

Accepted for publication September 26, 2005.

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