Rituximab responsive immune thrombocytopenic purpura in an adult with underlying autoimmune lymphoproliferative syndrome due to a splice-site mutation (IVS7+2 T>C) affecting the Fas gene

Andrew Wei, Tiffany Cowie

Research output: Contribution to journalArticleResearchpeer-review

12 Citations (Scopus)

Abstract

A 36 yr-old man of Israeli descent with a history of childhood splenectomy for severe thrombocytopenia and a family history of autoimmune lymphoproliferative syndrome (ALPS), presented with severe immune thrombocytopenic purpura refractory to standard therapy. He was found to possess a heterozygous mutation in the Fas gene (also termed TNFRSF6, CD95, Apo-1) affecting the donor splice site of intron 7 (IVS7+2 T>C). This frameshift mutation truncates the cytoplasmic domain of the Fas death receptor, resulting in circulating CD4/8 double negative T lymphocytes, lymphadenopathy and autoimmune complications typical of ALPS. Administration of Rituximab in this patient was associated with a durable hematologic response (currently more than 12 months). This report highlights the need to consider rare inherited causes of thrombocytopenia in adults with a family history of immune cytopenia(s) and the effective use of anti-CD20 monoclonal antibody in patients unresponsive to immunosuppression and splenectomy.

Original languageEnglish
Pages (from-to)363-366
Number of pages4
JournalEuropean Journal of Haematology
Volume79
Issue number4
DOIs
Publication statusPublished - 1 Oct 2007
Externally publishedYes

Keywords

  • Autoimmune lymphoproliferative syndrome
  • Fas
  • Immune thrombocytopenic purpura
  • Rituximab
  • TNFRSF6

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