Aplastic Crisis as Primary Manifestation of Systemic Lupus Erythematosus

Aplastic crisis is an unusual feature of systemic lupus
erythematosus (SLE). We report the case of a 54-year-old woman
presenting with both (extravascular) Coombs-positive hemolytic
anemia and laboratory findings of bone marrow hyporegeneration with
concomitant severe neutropenia. A bone marrow biopsy confirmed
aplastic crisis. Diagnostic work-up revealed soaring titers of
autoantibodies (anti-nuclear, anti-double-stranded DNA,
anti-cardiolipin-IgM, and anti-beta 2-glykoprotein-IgM antibodies),
indicating a connective tissue disease as the most plausible reason
for bone marrow insufficiency. As the criteria for SLE were
fulfilled, we initiated an immunosuppressive therapy by steroids,
which led to a rapid complete hematologic and clinical remission in
our patient. In this case, we could report on one of the rare cases
of SLE-induced aplastic crisis showing that this condition can be
entirely reversed by immunosuppressive treatment and that
SLE-induced aplastic crisis yields a good prognosis. In conclusion,
in a case of aplastic crisis, physicians should be aware that SLE
can be a rare cause that is accessible to specific treatment.