Concurrent Extracorporeal Membrane Oxygenation, Plasmapheresis and Continuous Renal Replacement Therapy in a Case of Wegener’s Granulomatosis.
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Date
2016-09
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Abstract
Wegener's Granulomatosis is one of the ANCA-associated vasculitis characterized by multifocal vascular necrotizing
inflammation and granulomas that commonly present with a pulmonary-renal syndrome. We report a case of 38 year-old
female patient who presented with acute respiratory distress syndrome due to diffuse alveolar hemorrhage and multiorgan
failure. The patient being in a hemodynamic collapse was aggressively intubated and supported by mechanical ventilation
and vasopressor therapy. Despite all effort refractory hypoxemia could not be coped with. Venovenous extracorporeal
membrane oxygenation was started through a femoral and jugular vein. Her oxygenation dramatically ameliorated after the
beginning of this procedure. 1 gr/day pulse metylprednisolone was administered followed by cyclophosphamide.
Concurrent continious renal replacement therapy and plasmapheresis was begun. Her clinical status improved in days
giving rise to weaning of the extracorporeal membrane oxygenation by the day twelve.
Extracorporeal membrane oxygenation is reported to be a successful mode of therapy in various cases in the literature
including diffuse alveolar hemorrhage due to ANCA-associated vasculitis and concurrent therapy with continuous
venovenous hemodialysis is reported to increase survival. Clinicians should be encouraged to use this life saving mode of
treatment more often.
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Keywords
ANCA, ECMO, granulomatosis with polyangiitis, plasmapheresis, Wegener’s granulomatosis
Citation
Yusuf Savran, Gencpinar T, Aydin K, Eroz E. Concurrent Extracorporeal Membrane Oxygenation, Plasmapheresis and Continuous Renal Replacement Therapy in a Case of Wegener’s Granulomatosis. Annals of International Medical and Dental Research. 2016 Sept-Oct; 2(5): 1-3.