Successful rituximab therapy in refractory autoimmune hepatitis and Evans syndrome

Elizabeth J. Carey, Krishni Somaratne, Jorge Rakela

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


A 44-year-old woman was found to have elevated aminotransferases, twice the upper limit of normal. Liver biopsy demonstrated a mixed inflammatory process suggestive of both primary biliary cirrhosis and autoimmune hepatitis (AIH). Prednisone and azathioprine were started, with normalization of aminotransferases. Six months later, she returned with worsening pruritus and re-evaluation demonstrated probable reactivation of AIH with acute elevation of liver injury tests. Repeat liver biopsy was suggestive of a flare of AIH which did not respond to prednisone, azathioprine, or mycophenolate mofetil. One month later the patient was hospitalized for sudden onset of anemia and thrombocytopenia, suggestive of autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura consistent with Evans syndrome. Rituximab was initiated and mycophenolate mofetil discontinued. After one infusion of rituximab, liver injury tests significantly improved. Within four weeks of rituximab infusion (4 doses) the patient's Evans syndrome completely resolved with normal hemoglobin and platelet levels; aminotransferases also significantly improved to less than twice the upper limit of normal.

Original languageEnglish (US)
Pages (from-to)1484-1487
Number of pages4
JournalRevista medica de Chile
Issue number11
StatePublished - Nov 2011


  • Anemia
  • Autoimmune
  • Evans syndrome
  • Hemolytic
  • Hepatitis
  • Rituximab

ASJC Scopus subject areas

  • General Medicine


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