Intravenous methylprednisolone or plasma exchange for adjunctive therapy of severe renal vasculitis?

2007 ◽  
Vol 4 (1) ◽  
pp. 14-15 ◽  
Author(s):  
David J Salant
Keyword(s):  
Plasma Exchange ◽  
Adjunctive Therapy ◽  
Intravenous Methylprednisolone ◽  
Renal Vasculitis

scholarly journals Randomized Trial of Plasma Exchange or High-Dosage Methylprednisolone as Adjunctive Therapy for Severe Renal Vasculitis

2007 ◽  
Vol 18 (7) ◽  
pp. 2180-2188 ◽  
Author(s):  
David R.W. Jayne ◽  
Gill Gaskin ◽  
Niels Rasmussen ◽  
Daniel Abramowicz ◽  
Franco Ferrario ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Plasma Exchange ◽  
Adjunctive Therapy ◽  
Renal Vasculitis

scholarly journals P.049 Medically refractory longitudinally extensive transverse myelitis successfully treated with cyclophosphamide induction

2016 ◽  
Vol 43 (S2) ◽  
pp. S32-S33
Author(s):  
LJ Baxter ◽  
S Chen ◽  
JM Burton
Keyword(s):  
Respiratory Failure ◽  
Plasma Exchange ◽  
Immune Therapy ◽  
Transverse Myelitis ◽  
Acute Disseminated Encephalomyelitis ◽  
High Dose ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Intravenous Methylprednisolone ◽  
Intensive Care Admission ◽  
Extensive Transverse Myelitis

Background: Longitudinally extensive transverse myelitis (LETM) is a demyelinating condition that is associated with diseases such as neuromyelitis optica spectrum disorder (NMOSD), acute disseminated encephalomyelitis, collagen vascular disease, or can be idiopathic. LETM can be severe enough to cause quadraparesis, marked sensory dysfunction, and respiratory failure. Rarely, these patients are unresponsive to conventional immune therapy. Methods: We report two cases of severe LETM with acute development of quadraparesis and respiratory failure requiring intensive care admission and failure to respond to high-dose corticosteroids, plasma exchange, IVIg and rituximab. Disease cessation and ultimately, significant recovery, was achieved after an 8-day cyclophosphamide induction. Results: A 21 yo female with antibody positive NMOSD and a 19 yo male with idiopathic LETM remained quadraparetic and ventilator dependent with active MRIs despite multiple courses of intravenous methylprednisolone, plasma exchanges, and in the NMOSD patient, IVIg and a 4-week course of rituximab. Both patients ultimately improved significantly and are now ambulatory with subsequent cyclophosphamide induction. Conclusions: In patients with severe LETM of presumed immune origin, who fail to respond to corticosteroids and plasma exchange, cyclophosphamide induction should be considered. This agent provides a more robust immunosuppressive response and can be induced rapidly. Cyclophosphamide effects and supportive evidence are further discussed.

Therapeutic Plasma Exchange in Neonatal Septic Shock: A Retrospective Cohort Study

2019 ◽  
Vol 37 (09) ◽  
pp. 962-969
Author(s):  
Taylor Sawyer ◽  
Zeenia Billimoria ◽  
Sarah Handley ◽  
Kendra Smith ◽  
Larissa Yalon ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Plasma Exchange ◽  
Retrospective Cohort Study ◽  
Adjunctive Therapy ◽  
Retrospective Cohort ◽  
Life Support ◽  
Therapeutic Plasma Exchange ◽  
Convenience Sample ◽  
Icu Discharge

Objective This study aimed to examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p < 0.001). Platelet levels did not change (median before TPE: 73,000/mm3 [IQR: 49,000–100,000] vs. median after TPE: 80,000/mm3 (IQR: 62,000–108,000); p = 0.2). Organ failure indices improved after TPE in two of the three neonates. Hypocalcemia was seen in all cases despite prophylactic calcium infusions. One neonate died, and two survived to ICU discharge. Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

Influence of Plasma Exchange on Serum Levels of Cytokines and Adhesion Molecules in ANCA-Positive Renal Vasculitis

1998 ◽  
Vol 16 (2) ◽  
pp. 72-80 ◽  
Author(s):  
V. Tesař ◽  
E. Jelínková ◽  
Z. Mašek ◽  
M. Jirsa Jr. ◽  
J. Žabka ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Adhesion Molecules ◽  
Serum Levels ◽  
Renal Vasculitis

Dramatic worsening following plasma exchange in severe post-natalizumab withdrawal multiple sclerosis relapse

2011 ◽  
Vol 17 (12) ◽  
pp. 1520-1522 ◽  
Author(s):  
C Papeix ◽  
R Depaz ◽  
A Tourbah ◽  
B Stankoff ◽  
C Lubetzki
Keyword(s):  
Multiple Sclerosis ◽  
Plasma Exchange ◽  
Young Woman ◽  
Subsequent Treatment ◽  
Intravenous Methylprednisolone ◽  
Multiple Sclerosis Relapse ◽  
First Relapse ◽  
Natalizumab Discontinuation

We report the case of a young woman with multiple sclerosis who discontinued natalizumab twice and experienced a severe relapse following each natalizumab withdrawal. The first relapse was successfully treated by intravenous methylprednisolone (IVMP). In contrast the second relapse was unresponsive to IVMP. Subsequent treatment by plasma exchanges (PLEX) was followed by a dramatic neurological worsening. This case suggests that PLEX after natalizumab discontinuation may increase relapse severity.

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