Pulse corticosteroid therapy for refractory thrombocytopenia in systemic lupus erythematosus

A patient with systemic lupus erythematosus and severe thrombocytopenia was refractory to therapy with prednisone, alone or in combination with cyclophosphamide or vincristine. Intravenous pulse therapy with methylprednisolone was associated with an increased platelet count from 4,000/mm3, to 52,000/mm3, but the response was short-lived. A second course of pulse therapy was also successful, and splenectomy was safely performed. The platelet count has remained normal for 15 months after surgery, allowing prednisone to be tapered and discontinued. Intravenous pulse therapy with methylprednisolone may be a safe alternative in preparing patients with profound, refractory thrombocytopenia for splenectomy.