Refractory Autoimmune Hemolytic Anemia in a Child Resolved After Benign Ovarian Tumor Resection: A Case Report

Autoimmune hemolytic anemia (AIHA) is a rare immune-mediated disorder in children that can present as primary or secondary to other diseases.Here, we report an unusual case of steroid-refractory warm AIHA in an 11-year-old girl whose condition was ultimately cured after removal of a benign ovarian tumor.Despite receiving multiple lines of therapy-including corticosteroids, rituximab, cyclosporine, sirolimus, and mycophenolate mofetil-the patient experienced recurrent hemolysis and steroid dependence for nearly four years.Abdominopelvic imaging performed to evaluate fever revealed bilateral ovarian cystic lesions, including a left-sided dermoid cyst.Surgical resection of the tumor led to complete and sustained hematologic remission, with normalization of hemoglobin, bilirubin, and reticulocyte counts, allowing discontinuation of all immunosuppressive agents.No recurrence of hemolysis was observed during 18 months of follow-up.This case highlights the potential for benign ovarian tumors to act as a rare secondary cause of AIHA through paraneoplastic or immune cross-reactive mechanisms.Awareness of such associations is crucial when evaluating pediatric patients with refractory or relapsing AIHA, as identification and removal of an occult tumor may achieve definitive resolution of hemolysis and avoid long-term immunosuppression.