Use of therapeutic plasma exchange in the management of acute hemorrhagic leukoencephalitis: a case report and review of the literature

Abstract

AHLE has a fulminant course requiring accurate and rapid diagnosis. Successful therapy requires aggressive management of intracranial pressure and immunosuppression. Two other reports of AHLE document successful management with TPE. Each of these patients survived with minimal neurologic impairments. Given the likely immune-mediated nature of this disease, combined treatment of steroids, surgery, and TPE may lead to shorter hospital stays and improved neurologic outcomes. Clinical studies are needed to further study the effect of TPE on neurologic outcome in AHLE.

Clinical Reasoning: Acute onset facial droop in a 36-year-old pregnant woman

“…10 Early diagnosis and treatment is paramount; treatment options include immunosuppression with high-dose steroids, cyclophosphamide, plasmapheresis, and management of elevated intracranial pressure. AHLE is a rapidly progressive, devastating disease.…”

Postpartum Lady with Bleed in the Brain: A Rare Manifestation of Neuroleptospirosis with Acute Haemorrhagic Leucoencephalitis (AHLE)

“…Treatment for AHLE is not well-established; some authors describe in recent literature that a combination of immunosuppressant medications and/or therapeutic plasma exchange may be of benefit in the treatment given the underlying cellular-humoral mediation and molecular mimicry [7]. General treatment includes aggressive management of cerebral oedema, surgical intervention in the event of increasing intracranial hypertension and other general measures in caring for the critically ill patients.…”

Fulminant Demyelinating Diseases

“…The CSF findings may show a polymorphonuclear pleocytosis in contrast to the lymphocytic pleocytosis seen in ADEM and can be mistaken for CNS infection. 25 Case reports describe presentations with a fulminant and fatal course and others improving with corticosteroids and plasma exchange (PLEX). 25 Larger series of ADEM do indicate that there is a radiographic spectrum, with some ADEM cases demonstrating hemorrhagic involvement.…”

“…25 Case reports describe presentations with a fulminant and fatal course and others improving with corticosteroids and plasma exchange (PLEX). 25 Larger series of ADEM do indicate that there is a radiographic spectrum, with some ADEM cases demonstrating hemorrhagic involvement. 8 …”