Pure Red Cell Aplasia and Autoimmune Hemolytic Anemia Sequentially Occurring in a Patient with Large Granular T-lymphocytic Leukemia

Pure red cell aplasia (PRCA), a type of anemia, occurred in a 50-year-old man six weeks after a splenectomy. It was successfully controlled by ciclosporin A (CsA) treatment. However, the onset of acute autoimmune hemolytic anemia (AIHA) developed one week after the CsA had been tapered off. Fortunately, the AIHA responded well to a high-dose methylprednisolone and immunoglobulin treatment. Unexpectedly, the patient suffered from severe pulmonary infection three months after the AIHA therapy. Four months later, he completely stopped the methylprednisolone. The disease was diagnosed as large granular T-lymphocytic leukemia by T cell receptor gene rearrangement, a surface marker examination and immunohistochemical staining. To our knowledge, no similar cases have previously been reported in the literature.