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Danazol Therapy in Thrombocytopenia Associated with the Antiphospholipid Antibody Syndrome
- Arthur Kavanaugh, MD
- From the Dallas Department of Veterans Affairs Medical Center and the University of Texas Southwestern Medical Center, Dallas, Texas. Requests for Reprints: Arthur Kavanaugh, MD, Rheumatic Diseases Division, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-8577. Acknowledgments: The author thanks the rheumatology fellows and internal medicine residents who participated in the care of this patient.
Thrombocytopenia has long been recognized as one of the cardinal manifestations of the antiphospholipid antibody syndrome [1]. In patients with the antiphospholipid antibody syndrome or conditions such as systemic lupus erythematosus, a clear correlation exists between the presence of antiphospholipid antibodies and thrombocytopenia [2]. Although the mechanism of thrombocytopenia in the antiphospholipid antibody syndrome has not been defined, therapy directed specifically toward the thrombocytopenia in this syndrome may be similar to that used in other types of immune thrombocytopenia. Danazol, an attenuated androgen, has proved to be efficacious in the treatment of refractory thrombocytopenia in idiopathic thrombocytopenic purpura [3, 4] and in systemic lupus erythematosus [5]. We describe the successful use of danazol as a steroid-sparing agent for thrombocytopenia in a patient with the antiphospholipid antibody syndrome.
Case Report
A 43-year-old man was well until 1984, when he had two episodes of lower-extremity deep venous thrombosis and pulmonary embolism; he was noted to have thrombocytopenia (platelet count, 9 × 109/L). Treatment with warfarin was initiated and was continued for 1 year. Prednisone (40 mg/d) increased the platelet count, but thrombocytopenia recurred when attempts were made to taper the dose, so a splenectomy was done. Despite a transient increase in the platelet count, corticosteroids were again required to maintain the platelet count in …
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