Back to Search Start Over

A successful plasma exchange in bridging to rituximab for severe neuropsychiatric lupus and lupus nephritis with viral infections and aspiration pneumonia.

Authors :
Kagitani M
Fujiki Y
Suzuka T
Ooe K
Sakamoto A
Takeuchi T
Azuma H
Source :
Modern rheumatology case reports [Mod Rheumatol Case Rep] 2024 Jul 08; Vol. 8 (2), pp. 276-279.
Publication Year :
2024

Abstract

Systematic lupus erythematosus (SLE) is a chronic autoimmune disease involving several organs such as the kidneys, skin, vessels, and central nervous system. Neuropsychiatric SLE (NPSLE) is a life-threatening condition that needs treatment with the combination of glucocorticoids and Immunosuppressants (IS). This includes cyclophosphamide and rituximab (RTX) which can lead to several infections. Therapeutic apheresis is an optional treatment for inflammatory diseases and has less risks of infections than IS. Plasma exchange (PE) is one of the most common apheresis, and is recommended for the management of NPSLE. We report a refractory NPSLE case with bacterial pneumonia and cytomegalovirus antigenemia. PE was performed prior to RTX. After the initiation of RTX which was incompatible due to infection such as aspiration pneumonia and cytomegalic virus, PE was scheduled considering the pharmacokinetics of RTX. Her SLE activity was well managed after PE and RTX without flare. PE treatment plan bridging to IS and RTX may effectively work in refractory SLE patients with infections.<br /> (© Japan College of Rheumatology 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Details

Language :
English
ISSN :
2472-5625
Volume :
8
Issue :
2
Database :
MEDLINE
Journal :
Modern rheumatology case reports
Publication Type :
Academic Journal
Accession number :
38113898
Full Text :
https://doi.org/10.1093/mrcr/rxad069