Coincidence of Severe Aplastic Anaemia with Multiple Sclerosis or Thyroid Disorders

Abstract

Five patients with severe aplastic anaemia (SAA) who, simultaneously (n = 3) or consecutively (n = 2), presented with multiple sclerosis (MS) (n = 2) or immune hyperthyroidism (IHT) (n = 2) or subacute thyroiditis (n = 1) are described. Two female patients with MS developed SAA after a small dose of azathioprine. Another patient simultaneously presented with IHT and SAA. SAA and MS responded to cyclosporine while IHT required ¹³¹I. Relapsing SAA in 1 patient with MS was treated with antithymocyte globulin (ATG) which induced acute exacerbation of MS. Despite the low total dose of ATG (31.5 mg/kg), complete remission of SAA was obtained. Two other patients developed thyroid disorders, 42 and 106 months after successful immunosuppression with ATG/high-dose methylprednisolone. IHT and subacute thyroiditis were successfully treated with ¹³¹I or prednisolone, respectively, without recurrence of SAA in both cases. These are the first documented cases of SAA evolving in the course of MS while the coincidence with IHT was already described. Since enhanced expression of interferon-γ plays a crucial role in SAA as well as in MS and in IHT, similar pathogenetic principles may apply for these seemingly unrelated disorders.

Graves’ disease following successful treatment of severe aplastic anaemia with antilymphocyte globulin

“…Interferon‐γ and tumour necrosis factor‐α are thought to have important roles in many autoimmune conditions so a greater frequency of such diseases in ALG treated patients is to be expected. In support of this, exacerbation of multiple sclerosis following treatment of aplastic anaemia with ALG has been reported ( Hinterberger‐Fischer et al . 1994 ) and interferon‐γ is thought to play a role in the pathogenesis of this condition.…”

Diagnosis of acquired aplastic anemia

“…[37][38][39] In a single-center report, 5.3% of the patients had an AID before the diagnosis of AA and 4.5% of them developed an AID after diagnosis and treatment for AA. 40 AID can appear at any time before or after the AA.…”

Primary Hyperthyroidism Induced Erythropoietin-resistant Anemia?

“…It has previously been reported that serum EPOlevels are increased in hyperthyroid patients, and that T4 and T3 stimulate EPO synthesis (1 1). Induction of anemia in non-hemodialysis patients due to a hyperthyroid state has been reported, although rarely, but in those cases, it was caused by hemolytic anemia and aplastic anemia (5,12,13). As far as we know, there have been no reports of primary hyperthyroidisminduced hemolytic anemia or aplastic anemia in hemodialysis patients.…”