Vol.21 No.5

Case Report

Hemophagocytic syndrome in a patient with rheumatoid arthritis

Authors

Hideki Tsuboi1,2 , Hirokazu Iwata1 , Akihide Nampei1 , Masato Matsushita2 , Kenrin Shi3

  • Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Cho, Sakai, 591-8025, Japan
  • Department of Rheumatology, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
  • Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
Received:

16 September 2010

Accepted:

1 February 2011

Published online:

22 February 2011

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Abstract

A 76-year-old man with rheumatoid arthritis, who had been treated with oral prednisolone and methotrexate, presented with high fever and generalized fatigability. Laboratory data demonstrated marked pancytopenia, which we first regarded as a side effect of methotrexate, and leucovorin was administered with granulocyte-colony stimulating factor and transfusions. Because no recovery was recognized, however, bone marrow aspiration was performed, by which hemophagocytic syndrome was diagnosed. After corticosteroid pulse therapy was initiated, the patient’s symptoms were rapidly attenuated and laboratory data rapidly normalized.

Key words

Corticosteroid - Hemophagocytic syndrome - Methotrexate - Pancytopenia - Rheumatoid arthritis