Introduction: Hematologic manifestations of Systemic Lupus Erythematosus (SLE) such as hemolytic anemia, leucopenia and thrombocytopenia are among the common causes of morbidity and hospitalization among patients. This is a case report of a patient presenting with refractory cytopenias.

Case: The patient is a 42-year-old female, diagnosed with SLE, having met the Systemic Lupus Erythematosus International Collaboration Clinics Criteria for diagnosis Persistent serositis (pleural effusion and ascites) and worsening of anemia prompted treatment with oral corticosteroid (prednisone 1.0 mg per kg per day) which showed improvement of shortness of breath and pleural effusion. Cytopenias persisted despite increasing IV pulse steroid to 6.0 mkd prednisone then further to 13 mkd prednisone. Rituximab given as 1.0 g infusion once every two weeks for two doses which resulted to improvement of anemia, thrombocytopenia and serositis.

Conclusion: Hematologic manifestations may present as life threatening complications of lupus. Most cases are responsive to corticosteroid therapy, however, in a few refractory cases, less used conventional treatment such as rituximab, may provide significant response.

Key words: systemic lupus erythematosus, ANA, ritumixab  

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