Plasmapheresis for diffuse alveolar hemorrhage in a patient with Wegener's granulomatosis: Case report and review of the literature

✍ Scribed by Thong Nguyen; Meri King Martin; Alexander J. Indrikovs

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 222 KB
• Volume: 20
• Category: Article
• ISSN: 0733-2459
• DOI: 10.1002/jca.20069

✦ Synopsis

We present a case of a 20-year-old male with Wegener's Granulomatosis involving the upper respiratory tract, lungs, and kidneys. In his fourth hospital admission, the patient presented with diffuse alveolar hemorrhage and poor pulmonary function: FiO 2 of 100% and PEEP of 17cm H 2 O on intubation. Due to a fast clinical deterioration while receiving drug therapy (cyclophosphamide and methylprednisolone), we performed nine daily 1-volume therapeutic plasma exchanges (TPE) using 5% albumin as replacement fluid. TPE resulted in a decrease in cytoplasmic anti-neutrophil cytoplasm antibodies (c-ANCA) titer from 1:1,024 to 1:16. On the ninth day of plasmapheresis, his pulmonary status was markedly improved with FiO 2 of 60% and PEEP of 8 cm H 2 O. The patient was later extubated and discharged home in stable condition. Wegener's Granulomatosis with pulmonary hemorrhage is not included in the current guidelines for therapeutic apheresis; therefore, we report this case and, if warranted, propose this condition to be included in the guidelines.