{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T12:55:35Z","timestamp":1777726535700,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Med Res"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Evans syndrome is an uncommon autoimmune disorder characterized by autoimmune hemolytic anemia and immune thrombocytopenia. It can follow a relapsing course in adults and may be challenging to treat. A woman in her 50s, diagnosed with Evans syndrome 2 years ago and on 10\u2009mg prednisolone once daily, presented with worsening symptoms, lymphadenopathy, and abnormal uterine bleeding. Lymph node biopsies revealed caseating and noncaseating granulomas, and infections and systemic autoimmune diseases were ruled out. She required intensive care unit admission and treatment with high-dose corticosteroids and rituximab. Plasmapheresis was attempted as the last-line therapy; however, it resulted in hemodynamic instability. This case reflects the clinical challenges involved in managing relapsed Evans syndrome in the absence of a clear secondary cause. The presence of granulomatous inflammation raises questions about lesser-known immune features of the disease. The use of plasmapheresis in unstable patients should be approached with caution.<\/jats:p>","DOI":"10.1177\/03000605251407450","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T04:46:35Z","timestamp":1766465195000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe relapse of Evans syndrome in an adult patient with treatment resistance and fatal outcome: A case report"],"prefix":"10.1177","volume":"53","author":[{"given":"Amr R","family":"Saleh","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Kafr Elsheikh University, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2369-7494","authenticated-orcid":false,"given":"Ziad W","family":"Elmezayen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kafr Elsheikh University, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6610-6841","authenticated-orcid":false,"given":"Alaa","family":"Zayed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eman Ali","family":"Elhawary","sequence":"additional","affiliation":[{"name":"Critical Care and Emergency Medicine Department, Faculty of Medicine, Kafr Elsheikh University, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1951.03810010058005"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9123851"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25574"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-04-215368"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/vcp.12774"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2017.12.009"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/head.12246"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.2147\/JBM.S176144"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.7421"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021005610"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2018.12.010"},{"key":"e_1_3_8_13_2","first-page":"e64866","article-title":"Diagnostic and therapeutic strategies in Evans syndrome: a case report and literature review","volume":"16","author":"Palvia AR","year":"2024","unstructured":"Palvia AR, Damera AR, Magar S, et\u00a0al. Diagnostic and therapeutic strategies in Evans syndrome: a case report and literature review. 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