Ravulizumab monotherapy for anti-CFH antibody-associated aHUS in an elderly patient: a case report highlighting individualized clinical decision-making.
Ryuichi Yoshii, Kengo Kajiwara, Keitaro Hirose et al.
✦ AI-curated · Sources linked
Case in brief
An 85-year-old man presented with acute kidney injury, thrombocytopenia, microangiopathic hemolytic anemia, and severe hypertension. Preserved ADAMTS13 activity and no identified secondary cause supported suspected complement-mediated thrombotic microangiopathy, but anti-CFH antibody results were unavailable during initial treatment decisions. Ravulizumab monotherapy was chosen after individualized assessment of the risks of plasma exchange and immunosuppression. Hematological parameters improved and renal function recovered sufficiently to stop hemodialysis. Subsequent testing found elevated anti-CFH antibodies and no pathogenic complement gene variants, confirming anti-CFH antibody-associated aHUS.
What made this case unusual
The diagnosis was confirmed only after treatment began, and the patient’s age and uncertainty about renal recovery complicated decisions about plasma exchange and immunosuppression. Ravulizumab was selected as an initial monotherapy approach in this context.
Diagnostic / clinical pearl
In suspected complement-mediated TMA, anti-CFH antibody results may not be available when treatment decisions are needed; interpret renal and hematological trends in context, particularly during hemodialysis.
Why it matters
The report emphasizes documenting patient-specific risks when selecting an initial approach and following anti-CFH antibody levels, with immunosuppression considered if titers persist or relapse risk remains high.