[Successful treatment with cyclosporine for myelodysplastic syndrome with erythroid hypoplasia following rheumatoid arthritis].

A 65-year-old female was admitted to our hospital for evaluation of transfusion-dependent progressive anemia. She had a history of rheumatoid arthritis for twenty-four years. Two years earlier, MDS (refractory anemia) was diagnosed based on laboratory findings and bone marrow examination. After diagnosis, the patient received anabolic steroid, Vitamin D3 and Vitamin K2. Although her hemoglobin level was maintained at 8.0 g/dl approximately 9.0 g/dl until January 2009, anemia gradually progressed thereafter. In April, we recognized marked anemia (Hb 6.0 g/dl) and reticulocytopenia (2.0 per thousand), but this was not accompanied by any other significant changes in laboratory findings. Bone marrow examination demonstrated a low percentage of erythroid precursors without an increase of blast cells. Rheumatoid arthritis remained stable by low dose steroid and NSAID administration. We did not recognize evidence suggesting any other cause of acquired PRCA, such as thymoma, human parvovirus B19 infection or drugs. A diagnosis of MDS with erythroid hypoplasia was made. The patient was successfully treated by an immunosuppressive regimen using cyclosporine. MDS with erythroid hypoplasia, coexisting with rheumatoid arthritis, is rare. To our knowledge, this is the third reported case.