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Refractory Autoimmune Hemolytic Anemia in a Pediatric SLE Patient Treated with Belimumab

A 14 year old girl with Systemic Lupus Erythematosus (SLE) presented with a refractory autoimmune hemolytic anemia (AIHA) as an isolated symptom of her underlying disease. We treated her with Belimumab for 11 months. Eventually, she got into complete remission and the corticosteroids could be tapered. However, after 11 months she had a relapse AIHA. There are multiple causes that could explain this. One might conclude that AIHA in SLE patients is less sensitive to Belimumab treatment and that the initial favorable response was caused by high doses prednisone. The true added value of Belimumab for the treatment of AIHA (in SLE patients) has to be determined in prospective clinical trials.