Recombinant Human Soluble Thrombomodulin for Treatment of Thrombotic Microangiopathy Associated with Lupus Nephritis: Table 1.

Abstract

To the Editor: Thrombotic microangiopathy (TMA) is a rare but frequently life-threatening complication of systemic lupus erythematosus (SLE). TMA is associated with a worse overall prognosis1,2 and usually requires plasma exchange in addition to immunosuppressive therapy. We treated a 33-year-old woman with SLE who developed TMA and renal dysfunction; she improved remarkably after intravenous (IV) administration of recombinant human soluble thrombomodulin (rTM) in addition to immunosuppressive therapy without plasma exchange. The patient presented to hospital with a fever with arthralgia, digital and palmar erythema, and alopecia for 2 weeks. Laboratory findings showed pancytopenia, proteinuria with cellular casts, positive antinuclear antibodies, anti-dsDNA antibody, and anticardiolipin antibody. She was diagnosed with SLE. She was initially treated with prednisolone 15 mg/day and aspirin 100 mg/day. After 1 week of treatment, she was admitted to hospital because of severe headache in addition to hypertension (200/110 mm Hg). Her body temperature was 37.4°C; she was conscious and alert. She had … Address correspondence to K. Tonooka; E-mail: k.tono{at}f4.dion.ne.jp