Cerebral lupus erythematosus responding to plasmaphaeresis

Evans, David T.; Giles, Michelle; Horne, Doug; d’Apice, Anthony J.F.; Riglar, A.; Toh, Ban‐Hock

doi:10.1136/pgmj.57.666.247

Cited by 15 publications

(10 citation statements)

References 15 publications

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“…TPE is particularly indicated in severe cases, such as in: rapid progression despite immunosuppressive therapy 34 renal involvement, eg, proliferative glomerulonephritis and nephrotic syndrome 35 – 37 extremely acute generalized vasculitis thrombocytopenia and leucopenia 28 , 38 pulmonary, cardiac, and cerebral involvement 39 , 40 pancreatitis. 41 …”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Therapeutic apheresis in autoimmune diseases

Bambauer¹,

Latza²,

Bambauer³

et al. 2013

OARRR

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Systemic autoimmune diseases based on an immune pathogenesis produce autoantibodies and circulating immune complexes, which cause inflammation in the tissues of various organs. In most cases, these diseases have a bad prognosis without treatment. Therapeutic apheresis in combination with immunosuppressive therapies has led to a steady increase in survival rates over the last 35 years. Here we provide an overview of the most important pathogenic aspects indicating that therapeutic apheresis can be a supportive therapy in some systemic autoimmune diseases, such as systemic lupus erythematosus, antiphospholipid syndrome, rheumatoid arthritis, and inflammatory eye disease. With the introduction of novel and effective biologic agents, therapeutic apheresis is indicated only in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents, and in patients with renal involvement, acute generalized vasculitis, thrombocytopenia, leucopenia, pulmonary, cardiac, or cerebral involvement. In mild forms of autoimmune disease, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of autoimmune diseases with varying organ manifestations has improved considerably in recent years, due in part to very aggressive therapy schemes.

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Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Therapeutic apheresis in autoimmune diseases

Bambauer¹,

Latza²,

Bambauer³

et al. 2013

OARRR

View full text Add to dashboard Cite

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“… References: #14 Jones; #15 Evans; #16 Tanter; #17 Kourilsky; #18 Gipstein; #9 Neuwelt; #4 Gokhale ‡IV‐CYC synchronized with PP; *part of Tanter literature review 16 ; §clinical image Arthritis and Rheumatism 1998 19:41;739, still receives PP six times per year via fistula into 2003 I‐Improved; S‐ stabilized; P‐ progressed;‡ IV‐CYC synchronized with PP; References: **new patients not previously reported. …”

Section: Methodsmentioning

confidence: 99%

“…In addition to new imaging findings, this review includes four patients treated with IV‐CYC/PP by our group since 1995 whose cases have not previously been published. A total of 26 patients will be discussed from the following publications: Jones (one patient, 1976; 11); Evans (one patient, 1981; 15); Tanter (nine patients, 1987; 16–18); Neuwelt (eight patients, 1995; 9,19,20); Gokhale (three patients, 2001; 4); and Neuwelt (four patients, 2003).…”

Section: Methodsmentioning

confidence: 99%

The Role of Plasmapheresis in the Treatment of Severe Central Nervous System Neuropsychiatric Systemic Lupus Erythematosus

Neuwelt

2003

Ther Apher Dial

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Twenty-six patients, who received plasmapheresis (PP) either alone or synchronized with cyclophosphamide (IV-CYC/PP), are retrospectively reviewed from Medline searches and personal experience from 1976 to 2002. Patients with central nervous system neuropsychiatric systemic lupus erythematosus (CNS-NPSLE) were evaluated according to the American College of Rheumatology (ACR) case definitions of 1999. Eleven of the patients were under the age of 21 years (range 7-21 years), highlighting the need for an aggressive treatment option for young patients who are refractory to other treatments. After treatment with PP or IV-CYC/PP, 74% of patients improved, 13% stabilized, and 13% progressed. Major side-effects occurred from central line placement rather than immunomodulation from PP itself Step-down therapies are needed to supplement IV-CYC/PP once improvement has reached a plateau. Newer combinations of PP and intravenous immunoglobulin (IVIg), human stem cell transplant (HSCT) and rituximab (RTX) should be considered in the future. In the absence of randomized controlled trials (RCT), experienced clinicians must weigh risk, benefit, and cost profiles in considering the treatment of severe CNS-NPSLE with PP.

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“…The present case did not respond to the intensive medical treatments which consisted of corticosteroid pulse therapy, cyclophosphamide pulse therapy, and synchronized plasmapheresis. Several reports have demonstrated clinical efficacy of the cyclophosphamide pulse therapy (9), steroid therapy, and synchronized plasmapheresis ( 10). Due to the rarity of this disorder, no prospective randomized investigations are available to evaluate these therapies, and the efficacy of synchronized plasmapheresis also remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Systemic Lupus Erythematosus Related Transverse Myelitis Presenting Longitudinal Involvement of the Spinal Cord.

et al. 2002

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Lupus-related transverse myelitis is a rare but serious complication. A 25-year-old Japanese womanwith systemic lupus erythematosus (SLE) was admitted because of numbness of the face and left upper extremity, headache, and intermittent fever. Six days later, she developed tetraplegia. MRI of the spinal cord showed longitudinal high intensity signals from medulla oblongata to C5, and from Thl2 to conus medullaris on T2-weighted image. These MRI findings wereconsistent with acute catastrophic neurological abnormalities. Despite administration of the combination of methylprednisolone and cyclophosphamide pulse therapies, as well as plasmapheresis, her condition did not improve. Any vasculopathy in addition to the autoimmune pathogenesis, and narrow therapeutic windowmayrelate to the present refractory case. (Internal Medicine 41: 156-160, 2002)

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Cerebral lupus erythematosus responding to plasmaphaeresis

Cited by 15 publications

References 15 publications

Therapeutic apheresis in autoimmune diseases

Therapeutic apheresis in autoimmune diseases

The Role of Plasmapheresis in the Treatment of Severe Central Nervous System Neuropsychiatric Systemic Lupus Erythematosus

Systemic Lupus Erythematosus Related Transverse Myelitis Presenting Longitudinal Involvement of the Spinal Cord.

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