Success of anti-CD20 monoclonal antibody treatment for severe autoimmune hemolytic anemia caused by warm-reactive immunoglobulin A, immunoglobulin G, and immunoglobulin M autoantibodies in a child: a case report.

BACKGROUND: Autoimmune hemolytic anemia is rare in children. First-line therapies for this disease consist of corticosteroids and intravenously administered immunoglobulin that are effective in most patients. However, a small proportion of cases (5 to 10%) is refractory to these therapies and may represent a medical emergency, especially when hemolysis is due to warm immunoglobulin M. Recently, reports of the use of rituximab in adult autoimmune diseases have shown promising results. In children, there are few studies on the use of rituximab in the treatment for autoimmune hemolytic anemia, especially on its long-term efficacy and adverse effects. CASE PRESENTATION: Here, we report the case of a 10-year-old Tunisian girl with refractory acute autoimmune hemolytic anemia caused by warm-reactive immunoglobulin A, immunoglobulin G, immunoglobulin M, and C3d autoantibodies. First-line treatments using corticosteroids and intravenously administered immunoglobulin were ineffective in controlling her severe disease. On the other hand, she was successfully treated with rituximab. In fact, her hemolytic anemia improved rapidly and no adverse effects were observed. CONCLUSIONS: The case that we report in this paper shows that rituximab could be an alternative therapeutic option in severe acute autoimmune hemolytic anemia with profound hemolysis refractory to conventional treatment. Moreover, it may preclude the use of plasmapheresis in such an urgent situation with a sustained remission.

[Indications and outcomes of surgical treatment of gastro-duodenal ulcer in child and adolescent. About 45 cases]. / Indications et resultats du traitement chirurgical des ulceres gastro-duodenaux de l'enfant et de l'adolescent. A propos de 45 cas.

The goal of this study was to determine the indications and assess the results of surgery in the treatment of gastro-duodenal ulcers in children and adolescents. This is a retrospective study of 45 patients operated for duodenal ulcer in Sahloul Teaching Hospital (Susa, Tunisia) over period of 14 years (1988 - 2001). The study is about 41 boys and 4 girls aged between 8 and 18 years (mean age: 15 1/2 years). Surgery was undertaker in cases of bleeding ulcer (9 cases), perforation (26 cases), stenosis (7 cases), resistance to medical treatment (3 cases). The after-effects were mild in 40 cases with an average hospital stay of 6 days. Later after-effects comprised ulcerous relapse (2 cases), stricture of the pyloroplasty (2 cases), an diarrhea follwing vagotomy combined with pyloroplasty in one case. Indications of surgical treatment of gastro-duodenal ulcers in children and adolescents are, nowadays, nearly limited to complicated forms of the illness. Outcomes of surgical treatment are globally satisfactory.