Autoimmune Thrombocytopenia Treated by Low-Dose Splenic Irradiation Followed by Splenectomy in a Patient With Systemic Lupus Erythematosus.

Severe autoimmune thrombocytopenia (ATP) in systemic lupus erythematosus (SLE) patients can be life-threatening when refractory to standard treatments. Low-dose splenic irradiation (LDSI) can provide temporary platelet recovery before definitive splenectomy. A 26-year-old woman with newly diagnosed SLE presented with severe thrombocytopenia (12,000/μL) and life-threatening bleeding. Despite multiple therapies, including prednisolone, cyclophosphamide, cyclosporine A, danazol, rituximab, and high-dose IVIg, thrombocytopenia persisted. LDSI (15 Gy in 15 fractions over 5 weeks) was performed, leading to rapid platelet recovery and enabling safe splenectomy, resulting in long-term remission. LDSI can serve as an effective bridging therapy in refractory ATP associated with SLE, allowing safer splenectomy and sustained remission.