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Methylprednisolone and plasmapheresis are effective for life-threatening diffuse alveolar hemorrhage and gastrointestinal hemorrhage in granulomatosis with polyangiitis: A case report and literature review.

Abstract The treatment of granulomatosis with polyangiitis (GPA) with life-threatening complications, such as diffuse alveolar hemorrhage (DAH) and gastrointestinal hemorrhage (GIH), remains challenging.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29703056
OWN - NLM
STAT- MEDLINE
DCOM- 20180507
LR  - 20180507
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 17
DP  - 2018 Apr
TI  - Methylprednisolone and plasmapheresis are effective for life-threatening diffuse 
      alveolar hemorrhage and gastrointestinal hemorrhage in granulomatosis with
      polyangiitis: A case report and literature review.
PG  - e0592
LID - 10.1097/MD.0000000000010592 [doi]
AB  - RATIONALE: The treatment of granulomatosis with polyangiitis (GPA) with
      life-threatening complications, such as diffuse alveolar hemorrhage (DAH) and
      gastrointestinal hemorrhage (GIH), remains challenging. PATIENT CONCERNS: A
      70-year-old female presented with a 6-month history of a productive cough and a
      10-day history of arthralgia that progressed to respiratory failure and massive
      hematochezia. DIAGNOSES: Chest high-resolution computed tomography (HRCT)
      revealed multiple nodules, masses, and cavities. Urinalysis indicated microscopic
      hematuria. Test of proteinase3-anti-neutrophil cytoplasmic autoantibody
      (PR3-ANCA) was positive. INTERVENTIONS: The patient was transferred to the
      intensive care unit (ICU) and successfully treated with glucocorticoid pulse
      therapy and plasmapheresis. We combined mycophenolate mofetil (MMF) with
      glucocorticoid for maintenance treatment. OUTCOMES: The patient survived and is
      in a stable condition. We report this case that presented with a productive
      cough, followed by arthralgia, DAH, and GIH. LESSONS: Effective
      remission-induction therapy is a key to survival, while maintaining a balance
      between immunosuppression and avoiding infection is another challenge.
FAU - Ning, Shen
AU  - Ning S
AD  - Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou,
      China.
FAU - Zhang, Xinhua
AU  - Zhang X
FAU - Xu, Cheng
AU  - Xu C
FAU - Dang, Xin
AU  - Dang X
FAU - Cheng, Hao
AU  - Cheng H
FAU - Zhu, Kejian
AU  - Zhu K
FAU - Han, Yongmei
AU  - Han Y
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Glucocorticoids)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Combined Modality Therapy
MH  - Female
MH  - Gastrointestinal Hemorrhage/etiology/*therapy
MH  - Glucocorticoids/*administration & dosage
MH  - Granulomatosis with Polyangiitis/*complications
MH  - Hemorrhage/etiology/*therapy
MH  - Humans
MH  - Lung Diseases/etiology/*therapy
MH  - Methylprednisolone/*administration & dosage
MH  - Plasmapheresis/*methods
MH  - Pulmonary Alveoli
EDAT- 2018/04/29 06:00
MHDA- 2018/05/08 06:00
CRDT- 2018/04/29 06:00
PHST- 2018/04/29 06:00 [entrez]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/05/08 06:00 [medline]
AID - 10.1097/MD.0000000000010592 [doi]
AID - 00005792-201804270-00088 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(17):e0592. doi: 10.1097/MD.0000000000010592.