Evans Syndrome in the Co-infection of HIV and Hepatitis C Virus: A Case Report
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Abstract
Evans syndrome (ES) which consists of the autoimmune hemolytic anemia (AIHA) and autoimmune thrombocytopenia (ITP) has rarely been reported in cases of co-infection of HIV and hepatitis C virus (HCV). Herein we report a case of the 31-year old woman who presents with acute gastroenteritis and fever for a few days. The physical examination reveals marked pallor without jaundice, no lymphadenopathy / hepatosplenomegaly. Her blood tests show: Hb 4.9 g%, WBC 6,000/mm3, platelet 105,000/mm3, MCV 65.3 fL, MCH 21.0 pg, reticulocyte 1.2 %, ferritin 4,610 ng/mL, direct Coombs’ test, anti-HCV and HIV Ag/Ab are all positive. The CD4 count is 409.3/mm3. Hb electrophoresis reveals Hb E disease. She is diagnosed as ES with co-infection of HIV and HCV, hemosiderosis and Hb E disease and she is treated with antiretroviral therapy and subsequently corticosteroid for ES. She can maintain her hemoglobin concentration without blood transfusion. It is not clear whether there is any association between ES and co-infection of HIV and HCV but at least ES and HIV-infected patients have one immune derangement in common, viz. the decrease of the CD4 cell activity. They are different for the CD8 cell count that is decreased in HIV-infected patients but increased in ES.
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