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.|
Use of high-dose corticosteroids and high-frequency oscillatory ventilation for treatment of a child with diffuse alveolar hemorrhage after bone marrow transplantation: case report and review of the literature.
|Publication Year Start||2018-01-01|
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.