AIHA in children younger than 2 years is in some cases characterized by a resistance to corticosteroids or dependence on high steroid doses and subsequent development of severe side effects [2] . Splenectomy or immunomodulating agents have frequently been used, but there is no consistent demonstration of their efficacy in controlling hemolysis [3] . Immunosuppressive drugs such as azathioprine, cyclosporine A, or cyclophosphamide, alone or in combination reduce steroid dependence and sometimes control hemolysis [1] [2] [3] [4] . Clinical experience with monoclonal antibodies appears encouraging. In particular, rituximab is increasingly being used off-label, for difficult-to-treat auto-immune diseases and presents the advantage of inducing a selective B-cell depletion, sparing cellular immunity mediated by T cells and natural killer cells. Even though prospective controlled studies are not currently available, the efficacy of rituximab has been shown in pediatric studies. Quartier et al. [5] treated five pediatric refractory AIHA patients, who achieved a complete remission within 15 to 22 months after rituximab therapy. These results were confirmed by Zecca et al. [6] in a group of 15 children treated with rituximab. Four other children were treated by Motto et al. [7] , with the achievement of complete remission. Nevertheless, the prolonged impairment of antibody production leads to an increased risk of viral and bacterial infections. For this reason, monthly intravenous immunoglobulin infusions are recommended for a minimum of 6 months following completion of therapy and prophylaxis for P. jirovecii pneumonia is also suggested [7] .