A 41-year-old woman developed nephrotic syndrome at the age of 32 and was diagnosed with minimal change nephrotic syndrome based on a renal biopsy. Although remission was achieved with administration of prednisolone (PSL) and cyclosporine, the nephrotic syndrome recurred. She was also started on rituximab (RTX). She developed late-onset neutropenia after RTX treatment (R-LON) and improved 17 days later. Although the majority of R-LON cases undergo spontaneous remission, cases of death have been reported. This report is intended to warn about R-LON, since the use of RTX for adult-onset nephrotic syndrome is expected to increase in the future.
Objective:
We report a patient with urosepsis, Lleptospira syndrome, TTP‐HUS syndrome, fulminant hepatic failure, vasculitis syndrome and TSS treated with plasma component exchange. Methods: Conditions for plasma component exchange were membrane plasma separator (Evacure EC‐3A), substitute fluid (3 % albumin solution), blood flow rate (150 mL/min), filtration rate (30 mL/min), quantity of substitute fluid (4,600 mL) and anticoagulant (nafamostat mesilate 30 mg/hr). Result: Plasma component exchange in combination with hemodiafiltration induced a rapid remission of both hepatic toxicity and renal failure caused by streptococcal sepsis. Membrane plasma separator evacure EC‐3A allowed the use of 3% albumin solution as substitute fluid. Colloid osmotic pressure temporarily increased after the treatment, but within 24 hours, returned to the same level as before the treatment. Conclusion: Plasma component exchange using a membrane plasma separator may allow the use of albumin instead of fresh frozen plasma (FFP) as substitute fluid, which results in a lower risk of infection.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.