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Open Access Case report

Eculizumab in paroxysmal nocturnal hemoglobinuria with Budd-Chiari syndrome progressing despite anticoagulation

Andrés Brodsky1*, Octavio Mazzocchi2, Fabiana Sánchez3, Gus Khursigara4, Suneil Malhotra4 and Mariano Volpacchio3

Author Affiliations

1 División Hematología, Hospital de Clínicas “José de San Martin”, Av. Córdoba 2351 (C1120AAR) Ciudad Autónoma de Buenos Aires, 5950-8000 Argentina

2 Departamento de Medicina, Hospital de Clínicas “José de San Martin”, Av. Córdoba 2351 (C1120AAR) Ciudad Autónoma de Buenos Aires, 5950-8000, Argentina

3 Diagnóstico por Imágenes, Hospital de Clínicas “José de San Martin”, Av. Córdoba 2351 (C1120AAR) Ciudad Autónoma de Buenos Aires, 5950-8000, Argentina

4 Alexion Pharmaceuticals, Inc.,, 352 Knotter Drive, Cheshire, CT, 06410, USA

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Experimental Hematology & Oncology 2012, 1:26  doi:10.1186/2162-3619-1-26

Published: 6 September 2012

Abstract

Paroxysmal nocturnal hemoglobinuria (PNH) is a progressive, life-threatening disorder characterized by chronic intravascular hemolysis caused by uncontrolled complement activation. Hepatic vein thrombosis (Budd-Chiari syndrome) is common in PNH patients. This case report describes the response to eculizumab (a humanized monoclonal antibody that inhibits terminal complement activation) in a 25-year-old male with progressive liver function deterioration despite standard anticoagulation therapy and transjugular intrahepatic porto-systemic shunt. The patient presented with anemia, severe thrombocytopenia, headache, abdominal pain, and distention. He was diagnosed with PNH, cerebral vein thrombosis, and Budd-Chiari syndrome. Despite adequate anticoagulation, diuretic administration, and placement of a transjugular shunt, additional thrombotic events and progressive liver damage were observed. Eculizumab therapy was initiated, resulting in rapid blockade of intravascular hemolysis, increased platelet counts, ascites resolution, and liver function recovery, all of which are presently sustained. Since starting eculizumab the patient has had no further thrombotic events and his quality of life has dramatically improved. This is the first report to confirm the role of complement-mediated injury in the progression of Budd-Chiari syndrome in a patient with PNH. This case shows that terminal complement blockade with eculizumab can reverse progressive thromboses and hepatic failure that is unresponsive to anticoagulation therapy and suggests that early initiation of eculizumab should be included in the therapeutic regimen of patients with PNH-related Budd-Chiari syndrome.

Keywords:
Budd-Chiari syndrome; Complement inhibition; Eculizumab; Paroxysmal nocturnal hemoglobinuria